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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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.
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