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Spirometric patterns in young and middle-aged adults: a 20-year European study
  1. Anne-Elie Carsin1,2,3,4,
  2. Judith Garcia-Aymerich1,2,3,
  3. Simone Accordini5,
  4. Shyamali Dharmage6,
  5. Bénédicte Leynaert7,
  6. Marti de las Heras1,2,3,
  7. Lidia Casas8,9,
  8. Seraina Caviezel10,
  9. Pascal Demoly11,12,
  10. Bertil Forsberg13,
  11. Thorarinn Gislason14,15,
  12. Angelo Guido Corsico16,17,
  13. Christer Janson18,
  14. Rain Jogi19,
  15. Jesús Martínez-Moratalla20,
  16. Dennis Nowak21,
  17. Leopoldo Palacios Gómez22,
  18. Isabelle Pin23,24,
  19. Nicole Probst-Hensch10,
  20. Chantal Raherison-Semjen25,
  21. Giulia Squillacioti26,
  22. Cecilie Svanes27,28,
  23. Kjell Torén29,30,
  24. Isabel Urrutia31,
  25. Ismael Huerta32,
  26. Josep Maria Anto1,2,3,
  27. Debbie Jarvis33,
  28. Stefano Guerra1,34
  1. 1 ISGlobal, Campus mar, Barcelona, Catalunya, Spain
  2. 2 Universita Pompeu Fabra (UPF), Barcelona, Spain
  3. 3 CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
  4. 4 Biometrics, RTI-Health Solutions, Barcelona, Spain
  5. 5 Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
  6. 6 Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
  7. 7 Université Paris-Saclay, UVSQ, Univ Paris-Sud, Inserm, INSERM, Paris, France
  8. 8 Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
  9. 9 Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Antwerpen, Belgium
  10. 10 Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
  11. 11 Département de Pneumologie et Addictologie, University Hospital of Montpellier, Montpellier, France
  12. 12 IDESP, University of Montpellier - Inserm UMR UA11, Montpellier, France
  13. 13 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  14. 14 Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
  15. 15 Medical Faculty, University of Iceland, Iceland, Iceland
  16. 16 Department of Internal Medicine and Therapeutics, University of Pavia, Italy, Italy
  17. 17 Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo—University of Pavia, Pavia, Italy
  18. 18 Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
  19. 19 Lung Clinic, Tartu University Hospital, Tartu, Estonia
  20. 20 Faculty of Medicine of Albacete, General University Hospital of Albacete, Albacete, Spain
  21. 21 Institute and Clinic for Occupational and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, member DZL, German Centre for Lung Research, Munich, Germany
  22. 22 Distrito Sanitario Huelva-Costa, Huelva, Spain
  23. 23 Department of Pediatrics, CHU de Grenoble Alpes, Grenoble, France
  24. 24 Inserm, UMR 1209, Institute for Advanced Biosciences, Grenoble, France
  25. 25 Inserm, UMR 1219, Université de Bordeaux, Bordeaux, France
  26. 26 Department of Public Health and Pediatrics, University of Turin, Torino, Piemonte, Italy
  27. 27 Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  28. 28 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
  29. 29 Department of Occupational and Environmental, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  30. 30 Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
  31. 31 Pulmonology Department, Galdakao Hospital, Biocruces Bizkaia, Spain
  32. 32 Epidemiological Surveillance Section, Directorate General of Public Health, Oviedo, Spain
  33. 33 National Heart and Lung Institute, Imperial College, London, UK
  34. 34 Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
  1. Correspondence to Anne-Elie Carsin, ISGlobal Instituto de Salud Global, Campus Mar, Barcelona, Catalunya, Spain; aeliecarsin.isglobal{at}


Background Understanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of restrictive and obstructive spirometric patterns occurring before 40 years (young onset) and between 40 and 61 years (mid-adult onset).

Methods We used data from the population-based cohort of the European Community Respiratory Health Survey (ECRHS). Prebronchodilator forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were assessed longitudinally at baseline (ECRHS1, 1993–1994) and again 20 years later (ECRHS3, 2010–2013). Spirometry patterns were defined as: restrictive if FEV1/FVC≥LLN and FVC<10th percentile, obstructive if FEV1/FVC<LLN or normal otherwise. Five spirometry patterns were derived depending on whether participants never developed restrictive/obstructive (normal), developed restrictive/obstructive at baseline (young onset) or at last follow-up (mid-adult onset). The characteristics and risk factors associated with these patterns were described and assessed using multilevel multinomial logistic regression analysis adjusting for age, sex, sample (random or symptomatic) and centre.

Results Among 3502 participants (mean age=30.4 (SD 5.4) at ECRHS1, 50.4 (SD 5.4) at ECRHS3), 2293 (65%) had a normal, 371 (11%) a young restrictive, 301 (9%) a young obstructive, 187 (5%) a mid-adult onset restrictive and 350 (10%) a mid-adult onset obstructive spirometric pattern. Being lean/underweight in childhood and young adult life was associated with the occurrence of the young spirometric restrictive pattern (relative risk ratio (RRR)=1.61 95% CI=1.21 to 2.14, and RRR=2.43 95% CI=1.80 to 3.29; respectively), so were respiratory infections before 5 years (RRR=1.48, 95% CI=1.05 to 2.08). The main determinants for young obstructive, mid-adult restrictive and mid-adult obstructive patterns were asthma, obesity and smoking, respectively.

Conclusion Spirometric patterns with onset in young and mid-adult life were associated with distinct characteristics and risk factors.

  • COPD epidemiology
  • Clinical Epidemiology

Data availability statement

Data are available upon reasonable request. Deidentified participant data can be made available upon reasonable request, after acceptance from the ECRHS centres involved.

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Data availability statement

Data are available upon reasonable request. Deidentified participant data can be made available upon reasonable request, after acceptance from the ECRHS centres involved.

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  • Contributors SG, JA and A-EC conceived the study design. SG, A-EC and MdlH analysed the results and interpreted the data. SG and A-EC drafted the manuscript. Critical revision of the manuscript for important intellectual content: A-EC, JG-A, SA, SD, BL, MdlH, LC, SC, PD, BF, TG, AGC, CJ, RJ, JM-M, DN, LPG, IP, NP-H, CR-S, GS, CS, KJ, IU, IH, JA, DJ, SG. A-EC had access to the data. A-EC and SG are the guarantors and accept full responsibility for the finished work and/or the conduct of the study, and controlled the decision to publish.

  • Funding This work was supported by FIS award PS09/01354 from the Instituto de Salud Carlos III. We acknowledge support from the Spanish Ministry of Science and Innovation through the ‘Centro de Excelencia Severo Ochoa 2019-2023’ Programme (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Programme. The funding agencies and principal investigators for the European Community Respiratory Health Survey are reported in the online supplemental appendix 1. The funding source had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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