Determinants of early-life lung function in African infants

Gray, Diane; Willemse, Lauren; Visagie, Ane; Czövek, Dorottya; Nduru, Polite M.; Vanker, Aneesa; Stein, Dan J.; Koen, Nastassja; Sly, Peter D.; Hantos, Zoltán; Hall, Graham L.; Zar, Heather J.

doi:10.1136/thoraxjnl-2015-207401

Cited by 70 publications

(94 citation statements)

References 43 publications

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“…The direction of associations between lower maternal education and lung function in our study was unexpected and not consistent with the weight of existing evidence regarding socio‐economic status (SES) and child health . While we do not have a good explanation for these findings, it could be chance findings in the context of multiple comparisons or inaccurate measurement of maternal education.…”

Section: Discussioncontrasting

confidence: 94%

Early life exposure to coal mine fire smoke emissions and altered lung function in young children

et al. 2019

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Background and objective Long‐term respiratory risks following exposure to relatively short periods of poor air quality early in life are unknown. We aimed to evaluate the association between exposure to a 6‐week episode of air pollution from a coal mine fire in children aged <2 years, and their lung function 3 years after the fire. Methods We conducted a prospective cohort study. Individual exposure to 24‐h average and peak concentrations of particulate matter with an aerodynamic diameter <2.5 μm in diameter (PM2.5) during the fire were estimated using dispersion and chemical transport modelling. Lung function was measured using the forced oscillation technique (FOT), generating standardized Z‐scores for resistance and reactance at a frequency of 5 Hz (Rrs5 and Xrs5), and area under the reactance curve (AX). We used linear regression models to assess the associations between PM2.5 exposure and lung function, adjusted for potential confounders. Results Of the 203 infants originally recruited, 84 aged 4.3 ± 0.5 years completed FOT testing. Median (interquartile range, IQR) for average and peak PM2.5 were 7.9 (6.8–16.8) and 103.4 (60.6–150.7) μg/m3, respectively. The mean ± SD Z‐scores for Rrs5, Xrs5 and AX were 0.56 ± 0.80, –0.76 ± 0.88 and 0.72 ± 0.92, respectively. After adjustment for potential confounders including maternal smoking during pregnancy, a 10 μg/m3 increase in average PM2.5 was significantly associated with worsening AX (β‐coefficient: 0.260; 95% CI: 0.019, 0.502), while the association between a 100‐μg/m3 increase in peak PM2.5 and AX was borderline (0.166; 95% CI: −0.002, 0.334). Conclusion Infant exposure to coal mine fire emissions could be associated with long‐term impairment of lung reactance.

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Section: Discussioncontrasting

confidence: 94%

Early life exposure to coal mine fire smoke emissions and altered lung function in young children

et al. 2019

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“…We have already described the negative impact of maternal smoking during pregnancy on lung function at 6 weeks in this cohort (35,36). The current study extends this by showing that the negative effect of maternal smoking persists to 1 year, an effect independent of infant growth and baseline lung function.…”

Section: Discussionsupporting

confidence: 71%

Lung Function in African Infants in the Drakenstein Child Health Study. Impact of Lower Respiratory Tract Illness

Gray

Turkovic

Willemse

et al. 2017

Am J Respir Crit Care Med

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Rationale: Lower respiratory tract illness is a major cause of childhood morbidity and mortality. It is unknown whether infants are predisposed to illness because of impaired lung function or whether respiratory illness reduces lung function.Objectives: To investigate the impact of early life exposures, including lower respiratory tract illness, on lung function during infancy.Methods: Infants enrolled in the Drakenstein child health study had lung function at 6 weeks and 1 year. Testing during quiet natural sleep included tidal breathing, exhaled nitric oxide, and multiple breath washout measures. Risk factors for impaired lung health were collected longitudinally. Lower respiratory tract illness surveillance was performed and any episode investigated. Measurements and MainResults: Lung function was tested in 648 children at 1 year. One hundred and fifty (29%) infants had a lower respiratory tract illness during the first year of life.Lower respiratory tract illness was independently associated with increased respiratory rate (4%; 95% confidence interval [CI], 1.01-1.08; P = 0.02). Repeat episodes further increased respiratory rate (3%; 95% CI, 1.01-1.05; P = 0.004), decreased tidal volume (21.7 ml; 95% CI, 23.3 to 20.2; P = 0.03), and increased the lung clearance index (0.13 turnovers; 95% CI, 0.04-0.22; P = 0.006) compared with infants without illness. Tobacco smoke exposure, lung function at 6 weeks, infant growth, and prematurity were other independent predictors of lung function at 1 year.Conclusions: Early life lower respiratory tract illness impairs lung function at 1 year, independent of baseline lung function. Preventing early life lower respiratory tract illness is important to optimize lung function and promote respiratory health in childhood.

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“…2 3 Furthermore, pneumonia or lower respiratory tract infection (LRTI) in early childhood has increasingly been associated with reduced lung function in infancy and the development of chronic non-communicable respiratory diseases, such as asthma or chronic obstructive pulmonary disease, in children and adults. [4][5][6][7] Pneumonia was formerly thought to occur after invasion of a sterile lower respiratory tract by a single pathogenic organism. However, recent evidence indicates that the healthy lung is not sterile and that the normal lung microbiome exists in a dynamic state.…”

Section: Introductionmentioning

confidence: 99%

Advances in the diagnosis of pneumonia in children

Zar

Andronikou

Nicol

2017

BMJ

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Pneumonia remains a major cause of childhood mortality and morbidity globally. Accurate diagnosis and attribution of the causes of pneumonia are important for measuring the burden of disease, implementing appropriate preventive or treatment strategies, and developing more effective interventions. This review summarizes recent diagnostic advances in radiological techniques, specimen collection, and laboratory methods. Although chest ultrasound and chest magnetic resonance imaging are promising modalities for radiological diagnosis, their role in clinical management and their impact on outcomes need further study. Rapid, highly sensitive, multiplex laboratory tests performed on upper respiratory tract samples or induced sputum can detect nucleic acid from potential pathogens in most children with pneumonia. However, it may be difficult to attribute causality because it is often impossible to distinguish between organisms colonizing or infecting the upper respiratory tract and those causing pneumonia. Currently available host biomarkers lack accuracy for distinguishing bacterial or mixed bacterial-viral infections from viral infections. New biomarkers derived from host transcriptional profile analysis may be more accurate but require validation. Prospective studies with appropriate control populations, including studies of clinical impact, are needed to improve our understanding of the role of tests. Although progress has been made in radiological techniques and laboratory testing, current methods for diagnosing and attributing the causes of pneumonia are suboptimal.

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Determinants of early-life lung function in African infants

Cited by 70 publications

References 43 publications

Early life exposure to coal mine fire smoke emissions and altered lung function in young children

Early life exposure to coal mine fire smoke emissions and altered lung function in young children

Lung Function in African Infants in the Drakenstein Child Health Study. Impact of Lower Respiratory Tract Illness

Advances in the diagnosis of pneumonia in children

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