Spirometric phenotypes from early childhood to young adulthood: a Chronic Airway Disease Early Stratification study

Abstract

BackgroundThe prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts.MethodsWe studied 49 334 participants from 14 population-based cohorts in different age-groups (≤10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as FEV1/FVC z-score <the lower limit of normal (LLN), whereas the restrictive as FEV1/FVC z-score ≥LLN, and FVC z-score <LLN.ResultsThe prevalence of obstructive and restrictive phenotypes varied from 3.2–10.9% and 1.8–7.7%, respectively, without clear age trends. A diagnosis of asthma (adjusted odds ratio, aOR=2.55 [95% CI=2.14–3.04]), preterm birth (aOR=1.84 [1.27–2.66]), maternal smoking during pregnancy (aOR=1.16 [1.01–1.35]), and family history of asthma (aOR=1.44 [1.25–1.66]) were associated with a higher prevalence of obstructive, but not restrictive phenotype across ages (5–25 years). A higher current body mass index (BMI) was more often observed in those with the obstructive phenotype but less in those with the restrictive (aOR=1.05 [1.03–1.06] and aOR=0.81 [0.78–0.85], per kg/m2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24 [1.05–1.46]).ConclusionObstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes.

Long-term expiratory airflow of infants born moderate-late preterm: A systematic review and meta-analysis

“…In addition, comparing to a population mean of 0 may have introduced bias given that poor GLI fit has been previously identified among several population groups. 56 , 57 , 58 We acknowledge that a limitation of our review is that we were unable to investigate longitudinal changes in expiratory airflows between MLP participants and term-born controls. Of the three studies with longitudinal outcomes, one used different reference equations at each time point, 37 while two studies reported z-scores derived from different reference equations.…”

Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children

“…In line with the Developmental Origins of Health and Disease (DOHaD) hypothesis, studies have suggested that the effect of respiratory tract infections in early life on respiratory health carries on until adulthood [34][35][36] . Additionally, lung function trajectories, either obstructive of restrictive phenotypes, are shown to persist into adolescence and adulthood 37 . Whether early-life risk factors, altered lung function, and diagnosis of asthma in childhood either separately of combined lead to adverse respiratory health such as asthma or COPD in adulthood need to be carefully elucidated.…”

Lung function in young adulthood: differences between males and females with asthma

“…Participants who had successfully performed a pre- and post-bronchodilator spirometry at the 24 years follow-up [ 17 ] and had information on whether the criteria for asthma at 24 years of age was fulfilled were included, resulting in a study population of 1928 participants.…”

“…The impact of asthma on lung function has previously been investigated [ 14 , 15 ]. Asthma and wheeze are strongly associated with an impaired lung function development [ 16 , 17 ], with a lower maximal lung function reached [ 16 ]. Lung function development in an individual tends to follow a trajectory, and a low lung function at an early age often results in a lower peak lung function [ 18 ] attained in early adulthood at 25–30 years of age [ 19 ].…”