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Children born with frail lungs — often because of toxic exposures during pregnancy — do not improve as they grow up, but suffer worsening breathing problems into adulthood, a UA study has found.

The ominous finding strengthens warnings to pregnant women to protect their fetuses from exposure to cigarette smoke, illicit drugs, even poor nutrition that can damage developing lungs.

Failure to do that sets the child up for a lifelong struggle with what is known as COPD — chronic obstructive pulmonary disease — that can significantly limit the activities and functions of normal life.

Premature birth and adolescent pregnancy also can result in underdeveloped lungs at birth.

"Parents must realize that any harmful exposures during the very delicate fetal period will have long-term consequences for the child," said Dr. Fernando Martinez, director of the Arizona Respiratory Center at the University of Arizona College of Medicine.

Martinez headed the two-decade-long study, with results published today in The Lancet, a British medical journal.

"What we found is that life — the process of aging — catches up with you sooner if you start out with poorer lung function."

Launched in the early 1980s, the study enrolled 123 infants at birth and tracked their lung function at intervals up to age 22.

The UA research team found that those babies born with poor airway function continued to suffer the problem at least through early adulthood.

"We have long known that fetal exposures such as tobacco smoke affect lung development," Martinez said.

"But what we did not know was if the problem persisted to adulthood, or if the lungs could gradually recover over the years of growth.

"In this study, we found that does not happen. At best, the lungs recover only partially. And it is likely the COPD worsens as the years go on because the aging process alone makes the lungs less efficient. So this will be a lifelong burden."

COPD occurs when the air-flow power of the lungs dips below 70 percent. At that level of lung strength, a person suffers impairment in overall physical function.

"You cannot do normal activities — it's not a normal life," Martinez said. "With severe COPD — when lung function falls below 40 percent — that's when you see people in wheelchairs with oxygen tanks."

In the United States, COPD affects about 40 percent of smokers older than age 50, and 20 percent to 30 percent of nonsmokers older than 65.

Both environmental and genetic factors can slow fetal lung development.

Among the risks parents can control are maternal smoking and exposure to secondhand smoke, maternal use of illicit drugs, and poor nutrition during pregnancy.

Not as controllable is premature birth. That and teen pregnancy also are linked to impaired lung function in babies.

"There have been huge advances in our ability to keep very premature babies alive, and that has been a great achievement," Martinez said.

"But we now realize these babies are born with very immature lungs.

"Knowing, as we do now, that this will follow them throughout their lives, we must admit there is a price to pay for that achievement."