TY - JOUR
T1 - Childhood respiratory risk factor profiles and middle-age lung function
T2 - A prospective cohort study from the first to sixth decade
AU - Bui, Dinh S.
AU - Walters, Haydn E.
AU - Burgess, John A.
AU - Perret, Jennifer L.
AU - Bui, Minh Q.
AU - Bowatte, Gayan
AU - Lowe, Adrian J.
AU - Russell, Melissa A.
AU - Thompson, Bruce R.
AU - Hamilton, Garun S.
AU - James, Alan L.
AU - Giles, Graham G.
AU - Thomas, Paul S.
AU - Jarvis, Debbie
AU - Svanes, Cecilie
AU - Garcia-Aymerich, Judith
AU - Erbas, Bircan
AU - Frith, Peter A.
AU - Allen, Katrina J.
AU - Abramson, Michael J.
AU - Lodge, Caroline J.
AU - Dharmage, Shyamali C.
PY - 2018/9
Y1 - 2018/9
N2 - Rationale: Childhood risk factors for long-term lung health often coexist and their specific patterns may affect subsequent lung function differently. Objectives: To identify childhood risk factor profiles and their influence on lung function and chronic obstructive pulmonary disease (COPD) in middle age, and potential pathways. Methods: Profiles of 11 childhood respiratory risk factors, documented at age 7, were identified in 8,352 participants from the Tasmanian Longitudinal Health Study using latent class analysis. We investigated associations between risk profiles and post-bronchodilator lung function and COPD at age 53, mediation by childhood lung function and adult asthma, and interaction with personal smoking. Results: Six risk profiles were identified: 1) unexposed or least exposed (49%); 2) parental smoking (21.5%); 3) allergy (10%); 4) frequent asthma, bronchitis (8.7%); 5) infrequent asthma, bronchitis (8.3%); and 6) frequent asthma, bronchitis, allergy (2.6%). Profile 6 was most strongly associated with lower forced expiratory volume in 1 second (FEV1) (2261; 95% confidence interval, 2373 to 2148 ml); lower FEV1/forced vital capacity (FVC) (23.4; 24.8 to 21.9%) and increased COPD risk (odds ratio, 4.9; 2.1 to 11.0) at age 53. The effect of profile 6 on COPD was largely mediated by adult active asthma (62.5%) and reduced childhood lung function (26.5%). Profiles 2 and 4 had smaller adverse effects than profile 6. Notably, the effects of profiles 2 and 6 were synergistically stronger for smokers. Conclusions: Profiles of childhood respiratory risk factors predict middle-age lung function levels and COPD risk. Specifically, children with frequent asthma attacks and allergies, especially if they also become adult smokers, are the most vulnerable group. Targeting active asthma in adulthood (i.e., a dominant mediator) and smoking (i.e., an effect modifier) may block causal pathways and lessen the effect of such established early-life exposures.
AB - Rationale: Childhood risk factors for long-term lung health often coexist and their specific patterns may affect subsequent lung function differently. Objectives: To identify childhood risk factor profiles and their influence on lung function and chronic obstructive pulmonary disease (COPD) in middle age, and potential pathways. Methods: Profiles of 11 childhood respiratory risk factors, documented at age 7, were identified in 8,352 participants from the Tasmanian Longitudinal Health Study using latent class analysis. We investigated associations between risk profiles and post-bronchodilator lung function and COPD at age 53, mediation by childhood lung function and adult asthma, and interaction with personal smoking. Results: Six risk profiles were identified: 1) unexposed or least exposed (49%); 2) parental smoking (21.5%); 3) allergy (10%); 4) frequent asthma, bronchitis (8.7%); 5) infrequent asthma, bronchitis (8.3%); and 6) frequent asthma, bronchitis, allergy (2.6%). Profile 6 was most strongly associated with lower forced expiratory volume in 1 second (FEV1) (2261; 95% confidence interval, 2373 to 2148 ml); lower FEV1/forced vital capacity (FVC) (23.4; 24.8 to 21.9%) and increased COPD risk (odds ratio, 4.9; 2.1 to 11.0) at age 53. The effect of profile 6 on COPD was largely mediated by adult active asthma (62.5%) and reduced childhood lung function (26.5%). Profiles 2 and 4 had smaller adverse effects than profile 6. Notably, the effects of profiles 2 and 6 were synergistically stronger for smokers. Conclusions: Profiles of childhood respiratory risk factors predict middle-age lung function levels and COPD risk. Specifically, children with frequent asthma attacks and allergies, especially if they also become adult smokers, are the most vulnerable group. Targeting active asthma in adulthood (i.e., a dominant mediator) and smoking (i.e., an effect modifier) may block causal pathways and lessen the effect of such established early-life exposures.
KW - Childhood
KW - Chronic obstructive pulmonary disease
KW - Lung function
KW - Profiles
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85052747345&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/299901
UR - http://purl.org/au-research/grants/NHMRC/1021275
UR - http://purl.org/au-research/grants/NHMRC/1101313
U2 - 10.1513/AnnalsATS.201806-374OC
DO - 10.1513/AnnalsATS.201806-374OC
M3 - Article
C2 - 29894209
AN - SCOPUS:85052747345
SN - 2325-6621
VL - 15
SP - 1057
EP - 1066
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 9
ER -