Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life
Open accessAbstract
Background Lifetime lung function is related to quality of life and longevity. Over the lifespan, individuals follow different lung function trajectories. Identification of these trajectories, their determinants, and outcomes is important, but no study has done this beyond the fourth decade.Methods We used six waves of the Tasmanian Longitudinal Health Study (TAHS) to model lung function trajectories measured at 7, 13, 18, 45, 50, and 53 years. We analysed pre-bronchodilator FEV 1 z-scores at the six timepoints using group-based trajectory modelling to identify distinct subgroups of individuals whose measurements followed a similar pattern over time. We related the trajectories identified to childhood factors and risk of chronic obstructive pulmonary disease (COPD) using logistic regression, and estimated population-attributable fractions of COPD.Findings Of the 8583 participants in the original cohort, 2438 had at least two waves of lung function data at age 7 years and 53 years and comprised the study population. We identified six trajectories: early below average, accelerated decline (97 [4%] participants); persistently low (136 [6%] participants); early low, accelerated growth, normal decline (196 [8%] participants); persistently high (293 [12%] participants); below average (772 [32%] participants); and average (944 [39%] participants). The three trajectories early below average, accelerated decline; persistently low; and below average had increased risk of COPD at age 53 years compared with the average group (early below average, accelerated decline: odds ratio 35·0, 95% CI 19·5-64·0; persistently low: 9·5, 4·5-20·6; and below average: 3·7, 1·9-6·9). Early-life predictors of the three trajectories included childhood asthma, bronchitis, pneumonia, allergic rhinitis, eczema, parental asthma, and maternal smoking. Personal smoking and active adult asthma increased the impact of maternal smoking and childhood asthma, respectively, on the early below average, accelerated decline trajectory.Interpretation We identified six potential FEV 1 trajectories, two of which were novel. Three trajectories contributed 75% of COPD burden and were associated with modifiable early-life exposures whose impact was aggravated by adult factors. We postulate that reducing maternal smoking, encouraging immunisation, and avoiding personal smoking, especially in those with smoking parents or low childhood lung function, might minimise COPD risk. 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.Funding National Health and Medical Research Council of Australia; European Union's Horizon 2020; The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; The Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline.
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More recent findings suggest that childhood asthma is related to longitudinal lung function trajectories that are "below normal" within both the general population and asthmatics.
“More recent findings suggest that childhood asthma is related to longitudinal lung function trajectories that are “below normal” within both the general population (162) and asthmatics (163).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [162]
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- Bui, D. S., Lodge, C. J., Burgess, J. A., Lowe, A. J., Perret, J., Bui, M. Q., Bowatte, G., Gurrin, L., Johns, D. P., Thompson, B. R., Hamilton, G. S., Frith, P. A., James, A. L., Thomas, P. S., Jarvis, D., Svanes, C., Russell, M., Morrison, S. C., Feather, I. ,... Dharmage, S. C. (2018). Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life. LANCET RESPIRATORY MEDICINE, 6 (7), pp.535-544. https://doi.org/10.1016/S2213-2600(18)30100-0. Persistent Link: http://hdl.handle.net/11343/213513 File Description: Accepted
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- Authors
- Bui, D. S., Lodge, C. J., Burgess, J. A., Lowe, A. J., Perret, J., Bui, M. Q., Bowatte, G., Gurrin, L., Johns, D. P., Thompson, B. R., Hamilton, G. S., Frith, P. A., James, A. L., Thomas, P. S., Jarvis, D., Svanes, C., Russell, M., Morrison, S. C., Feather, I., Allen, K. J., Wood-Baker, R., Hopper, J., Giles, G. G., Abramson, M. J., Walters, E. H., Matheson, M. C., & Dharmage, S. C.
- Affiliations
- The University of Melbourne (AU)
- University of Tasmania (AU)
- The Alfred Hospital (AU)
- Monash Health (AU)
- Flinders University (AU)
- Sir Charles Gairdner Hospital (AU)
- UNSW Sydney (AU)
- MRC Centre for Environment and Health (GB)
- Haukeland University Hospital (NO)
- The University of Queensland (AU)
- Gold Coast Hospital (AU)
- Royal Children's Hospital (AU)
- Cancer Council Victoria (AU)
- Monash University (AU)
- Corresponding author
- Dharmage, Shyamali C
- ORCID
- Bui, Dinh S
- Lodge, Caroline J
- Burgess, John A
- Lowe, Adrian J
- Perret, Jennifer
- Bui, Minh Q
- Bowatte, Gayan
- Gurrin, Lyle
- Johns, David P
- Hamilton, Garun S
- Frith, Peter A
- Thomas, Paul S
- Jarvis, Deborah
- Svanes, Cecilie
- Russell, Melissa
- Feather, Iain
- Allen, Katrina J
- Hopper, John
- Giles, Graham G
- Abramson, Michael J
- Walters, Eugene H
- Matheson, Melanie C
- Dharmage, Shyamali C
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 6
- Issue
- 7
- Pages
- 535-544
- ISSN
- 2213-2600 (ISSN-L)
- OpenAlex
- W2795922861
- Cited by
- 602
- References
- 38
- Citations by year
- 2026: 59 · 2025: 67 · 2024: 79 · 2023: 75 · 2022: 71 · 2021: 87 · 2020: 84 · 2019: 55 · 2018: 25
- FWCI
- 47.24
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- The Lancet Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- UTAS Research Repository (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
- Funders
- Pfizer
- Boehringer Ingelheim
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Keywords
- lung function trajectories, childhood lung function, chronic obstructive pulmonary disease risk, childhood asthma, maternal smoking, pediatric respiratory infection, allergic rhinitis, atopic dermatitis, adult smoking, population attributable fraction, lung function decline, childhood immunization, asthma control, group-based trajectory modeling
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Female, Forced Expiratory Volume, Humans, Infant, Infant, Newborn, Longitudinal Studies, Lung, Male, Middle Aged, Prospective Studies, Respiratory Function Tests, Risk, Tasmania, Cohort Studies, Age Distribution, Pulmonary Disease, Chronic Obstructive, Young Adult
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