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Am J Respir Crit Care Med. 2017 Jul 1;196(1):39-46. doi: 10.1164/rccm.201606-1272OC.

Childhood Lung Function Predicts Adult Chronic Obstructive Pulmonary Disease and Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome.

Author information

1
1 Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia.
2
2 University of Queensland, Brisbane, Queensland, Australia.
3
3 Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
4
4 University of New South Wales, Sydney, New South Wales, Australia.
5
5 Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia.
6
6 ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain.
7
7 Universitat Pompeu Fabra, Barcelona, Spain.
8
8 Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain.
9
9 Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
10
10 Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
11
11 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; and.
12
12 School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.

Abstract

RATIONALE:

The burden of chronic obstructive pulmonary disease (COPD) is increasing, yet there are limited data on early life risk factors.

OBJECTIVES:

To investigate the role of childhood lung function in adult COPD phenotypes.

METHODS:

Prebronchodilator spirometry was performed for a cohort of 7-year-old Tasmanian children (n = 8,583) in 1968 who were resurveyed at 45 years, and a selected subsample (n = 1,389) underwent prebronchodilator and post-bronchodilator spirometry. For this analysis, COPD was spirometrically defined as a post-bronchodilator FEV1/FVC less than the lower limit of normal. Asthma-COPD overlap syndrome (ACOS) was defined as the coexistence of both COPD and current asthma. Associations between childhood lung function and asthma/COPD/ACOS were examined using multinomial regression.

MEASUREMENTS AND MAIN RESULTS:

At 45 years, 959 participants had neither current asthma nor COPD (unaffected), 269 had current asthma alone, 59 had COPD alone, and 68 had ACOS. The reweighted prevalence of asthma alone was 13.5%, COPD alone 4.1%, and ACOS 2.9%. The lowest quartile of FEV1 at 7 years was associated with ACOS (odds ratio, 2.93; 95% confidence interval, 1.32-6.52), but not COPD or asthma alone. The lowest quartile of FEV1/FVC ratio at 7 years was associated with ACOS (odds ratio, 16.3; 95% confidence interval, 4.7-55.9) and COPD (odds ratio, 5.76; 95% confidence interval, 1.9-17.4), but not asthma alone.

CONCLUSIONS:

Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention. Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function.

KEYWORDS:

asthma–COPD overlap syndrome; childhood lung function; early life

PMID:
28146643
DOI:
10.1164/rccm.201606-1272OC
[Indexed for MEDLINE]
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