Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study

Abstract

BackgroundDevelopment of adult respiratory disease is influenced by events in childhood. The impact of childhood pneumonia on chronic obstructive pulmonary disease (COPD) is not well defined. We hypothesize that childhood pneumonia is a risk factor for reduced lung function and COPD in adult smokers.MethodsCOPD cases and control smokers between 45–80 years old from the United States COPDGene Study were included. Childhood pneumonia was defined by self-report of pneumonia at <16 years. Subjects with lung disease other than COPD or asthma were excluded. Smokers with and without childhood pneumonia were compared on measures of respiratory disease, lung function, and quantitative analysis of chest CT scans.ResultsOf 10,192 adult smokers, 854 (8.4 %) reported pneumonia in childhood. Childhood pneumonia was associated with COPD (OR 1.40; 95 % CI 1.17-1.66), chronic bronchitis, increased COPD exacerbations, and lower lung function: post-bronchodilator FEV1 (69.1 vs. 77.1 % predicted), FVC (82.7 vs. 87.4 % predicted), FEV1/FVC ratio (0.63 vs. 0.67; p < 0.001 for all comparisons). Childhood pneumonia was associated with increased airway wall thickness on CT, without significant difference in emphysema. Having both pneumonia and asthma in childhood further increased the risk of developing COPD (OR 1.85; 95 % CI 1.10-3.18).ConclusionsChildren with pneumonia are at increased risk for future smoking-related lung disease including COPD and decreased lung function. This association is supported by airway changes on chest CT scans. Childhood pneumonia may be an important factor in the early origins of COPD, and the combination of pneumonia and asthma in childhood may pose the greatest risk.Clinical trials registrationClinicalTrials.gov, NCT00608764 (Active since January 28, 2008).Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-015-0273-8) contains supplementary material, which is available to authorized users.

Bacterial Lung Disease and COPD

“…Similarly, a reduction of lung function by 0.17 litre (0.02 to 0.32) and higher mortality due to COPD in adults was observed in adults who had bronchitis or pneumonia in infancy [32]. This apparent association of childhood pneumonia in COPD development and severe COPD exacerbations [31] may relate to possible reduction in lung growth due to pneumonia [32] and also to inadequate treatment of pneumonia [33]. Regarding acute exacerbations of COPD, a study involving 1,114 subjects over 40 years of age from Korea identified that the exacerbation rate was many times higher (18-fold, p < 0.001) in COPD patients who had a previous history of pneumonia compared to patients who were not affected by pneumonia [34].…”

“…Hayden and colleagues in recent study of 10,192 adult current and former smokers, concluded that development of adult respiratory disease is influenced by childhood respiratory infections whereby childhood pneumonia was identified as a predictor of COPD (OR 1.40, 95% CI: 1.17-1.66) [31]. Similarly, a reduction of lung function by 0.17 litre (0.02 to 0.32) and higher mortality due to COPD in adults was observed in adults who had bronchitis or pneumonia in infancy [32].…”

Susceptibility to Childhood Pneumonia: A Genome-Wide Analysis

“…Pneumonia is less common in adults, although smokers are a subpopulation known to experience increased rates of pneumonia (3)(4)(5). Our previous investigations have demonstrated that pneumonia in childhood is a risk factor for chronic obstructive pulmonary disease (COPD), reduced lung function, and airway disease on chest computed tomography scans in adult smokers (6). This variability in the prevalence of childhood pneumonia and its association with an increased risk of lung disease later in life suggest some underlying genetic susceptibility.…”

“…Pneumonia was defined by subject selfreport, as described previously (6). The subjects were classified as having childhood pneumonia if their first episode was at ,16 years of age or during childhood, and lifetime pneumonia if they had ever had pneumonia.…”

Bending the Twig Does the Tree Incline: Lung Function after Lower Respiratory Tract Illness in Infancy

“…The results of the Drakenstein study add urgency to this task. LRTIs are known to be associated with the subsequent development of chronic pulmonary disease (10,11), which is one of the most frequent causes of early death in adults. The data presented here strongly suggest that the association may be causal.…”