Elsevier

The Lancet

Volume 370, Issue 9589, 1–7 September 2007, Pages 758-764
The Lancet

Articles
Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study

https://doi.org/10.1016/S0140-6736(07)61379-8Get rights and content

Summary

Background

Together with smoking, the lung function attained in early adulthood is one of the strongest predictors of chronic obstructive pulmonary disease. We aimed to investigate whether lung function in early adulthood is, in turn, affected by airway function measured shortly after birth.

Methods

Non-selected infants were enrolled at birth in the Tucson Children's Respiratory Study between 1980 and 1984. We measured maximal expiratory flows at functional residual capacity (VmaxFRC) in 169 of these infants by the chest compression technique at a mean of 2·3 months (SD 1·9). We also obtained measurements of lung function for 123 of these participants at least once at ages 11, 16, and 22 years. Indices were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of FVC (FEF25–75), both before and after treatment with a bronchodilator (180 μg of albuterol).

Findings

Participants who had infant VmaxFRC in the lowest quartile also had lower values for the FEV1/FVC ratio (−5·2%, p<0·0001), FEF25–75 (−663 mL/s, p<0·0001), and FEV1 (−233 mL, p=0·001) up to age 22, after adjustment for height, weight, age, and sex, than those in the upper three quartiles combined. The magnitude and significance of this effect did not change after additional adjustment for wheeze, smoking, atopy, or parental asthma.

Interpretation

Poor airway function shortly after birth should be recognised as a risk factor for airflow obstruction in young adults. Prevention of chronic obstructive pulmonary disease might need to start in fetal life.

Introduction

30 years ago, Burrows and coworkers made the seminal observation that adults with a history of paediatric respiratory illness had lower levels of lung function and were more likely to develop obstructive lung disease than those without such a history.1 One plausible interpretation of this finding is that respiratory infections can damage the lung and predispose to obstructive lung disease. However, events before any respiratory illness could also possibly predispose individuals both to these early illnesses and to subsequent chronic impairment of lung function.2 Our findings and those of others3, 4, 5, 6 supported this contention, by showing that children who presented with illnesses of the lower respiratory tract during their first years of life had lower maximal expiratory flows than others shortly after birth and before any such illnesses developed. These results suggest the hypothesis that chronic obstructive pulmonary disease has origins in fetal life, and specifically in the factors that determine intrauterine growth of lungs and airways.

Longitudinal studies have suggested that a substantial proportion of deficits in lung function that present during the third decade of life, and especially those in individuals who have a diagnosis of asthma, persist into late adulthood and predispose for the development of chronic obstructive pulmonary disease.7 We aimed to assess to what degree these deficits in lung function are already present in the early postneonatal period.

Section snippets

Participants

We enrolled 1246 healthy infants at birth, between 1980 and 1984, in the Tucson Children's Respiratory Study, a longitudinal non-selected cohort study.8 We developed a chest-compression technique, for assessment of pulmonary function in infancy, as the last 376 infants were enrolled in the study. Of these 376 eligible infants, 20 could not be contacted within the testing time, 111 did not have the consent of their parents, 27 had a lower respiratory infection, 35 did not fall asleep, seven were

Results

The 123 participants included in our study had more educated mothers (p=0·02) and more fathers with asthma (p=0·01) than the other 1123 children enrolled in the Children's Respiratory Study (table 1). Other than that, the baseline characteristics of the two groups did not differ.

Length-adjusted infant VmaxFRC did not seem to be associated with potential confounders such as birthweight or type of delivery, or parental ethnicity, asthma, smoking, age, or level of education (webtable 1). These

Discussion

We showed that up to 14% of the variance in measurements of airway function (FEV1, FEV1/FVC ratio, and FEF25–75) in young adults was related to the maximal flows at functional residual capacity (VmaxFRC), measured in the same individuals at 2 months. Infant lung function was correlated with all measurements of airway function at ages 11–22 years, but more strongly with measurements taken before bronchodilator use than with those after bronchodilation. Moreover, individuals who had low airway

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