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. 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

Dinh S Bui  1 , John A Burgess  1 , Adrian J Lowe  1 , Jennifer L Perret  1 , Caroline J Lodge  1 , Minh Bui  1 , Stephen Morrison  2 , Bruce R Thompson  3 , Paul S Thomas  4 , Graham G Giles  5 , Judith Garcia-Aymerich  6   7   8 , Debbie Jarvis  9   10 , Michael J Abramson  11 , E Haydn Walters  1   12 , Melanie C Matheson  1 , Shyamali C Dharmage  1
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Free article

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

Dinh S Bui et al. Am J Respir Crit Care Med. .
Free article

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.

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