COPD

COPD Risk Raised by Early, Impaired Lung Function

Various trajectories of impaired lung function beginning in childhood are associated with an elevated risk for chronic obstructive pulmonary disease (COPD) later in life, according to a new study.

For their study, the researchers modeled lung function trajectories measured at ages 7, 13, 18, 45, 50, and 53 years using data from 8583 patients and 6 waves of the Tasmanian Longitudinal Health Study.

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Pre-bronchodilator forced expiratory volume in 1 second z-scores for each time point were assessed via group-based trajectory modeling. Each trajectory was subsequently related to childhood factors and COPD risk using logistic regression, and population-attributable fractions of COPD were estimated.

A total of 2438 of 8583 patients had available data on at least 2 waves of lung function at ages 7 years and 53 years, and were included in the present analysis. Six lung function trajectories were identified:

  • Early below average, accelerated decline (n = 97)
  • Persistently low (n = 136)
  • Early low, accelerated growth, normal decline (n = 196)
  • Persistently high (n = 293)
  • Below average (n = 772)
  • Average (n = 944)

Results of the study indicated that patients in the early below average, accelerated decline (odds ratio [OR] 35.0); persistently low (OR 9.5); and below average (OR 3.7) trajectory groups had an elevated risk for COPD at age 53 years compared with patients in the average group.

The researchers found that childhood asthma, bronchitis, pneumonia, allergic rhinitis, eczema, parental asthma, and maternal smoking were all early-life predictors of all 3 of these trajectories.

In addition, personal smoking and active adult asthma were found to increase the impact of maternal smoking and childhood asthma, respectively, among patients in the early below average, accelerated decline trajectory group.

“Clinicians and patients with asthma should be made aware of the potential long-term implications of non-optimal asthma control for lung function trajectory throughout life, and the role and benefit of optimal asthma control on improving lung function should be investigated in future intervention trials,” the researchers concluded.

—Christina Vogt

Reference:

Bui DS, Lodge CJ, Burgess JA, et al. Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life. Lancet Respir Med. 2018;6(7):535-544. https://doi.org/10.1016/S2213-2600(18)30100-0