Childhood respiratory risk factor profiles and middle-age lung function: a prospective cohort study from the first to sixth decade
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Abstract 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) (−261; 95% confidence interval, −373 to −148 ml); lower FEV1/forced vital capacity (FVC) (−3.4; −4.8 to −1.9%) 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.
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Childhood asthma has been associated with adult lung function deficits and increased risk of COPD.
“Childhood asthma has been associated with adult lung function deficits and increased risk of COPD (157–159).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [159]
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- Authors
- Bui, D. S., Walters, H. E., Burgess, J. A., Perret, J. L., Bui, M. Q., Bowatte, G., Lowe, A. J., Russell, M. A., Thompson, B. R., Hamilton, G. S., James, A. L., Giles, G. G., Thomas, P. S., Jarvis, D., Svanes, C., Garcia-Aymerich, J., Erbas, B., Frith, P. A., Allen, K. J., Abramson, M. J., Lodge, C. J., & Dharmage, S. C.
- Affiliations
- The University of Melbourne (AU)
- Allergy and Lung Health Unit, University of Melbourne, Melbourne, Victoria, Australia
- The Alfred Hospital (AU)
- Monash Health (AU)
- The University of Western Australia (AU)
- Cancer Council Victoria (AU)
- UNSW Sydney (AU)
- Department of Epidemiology & Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, and
- Haukeland University Hospital (NO)
- ISGlobal, Centre for Research in Environmental Epidemiology, Barcelona, Spain
- La Trobe University (AU)
- Flinders University (AU)
- Royal Children's Hospital (AU)
- Monash University (AU)
- Corresponding author
- Dharmage, Shyamali C.
- ORCID
- Venue
- Annals of the American Thoracic Society
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-09-01
- Volume
- 15
- Issue
- 9
- Pages
- 1057-1066
- ISSN
- 2325-6621 (ISSN-L)
- 2329-6933
- OpenAlex
- W2807870020
- Cited by
- 71
- References
- 35
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 17 · 2023: 6 · 2022: 10 · 2021: 5 · 2020: 7 · 2019: 11 · 2018: 5
- FWCI
- 5.27
- Type
- journal article
- Language
- en
- Open access
- green
- research.monash.edu
- Locations
- Annals of the American Thoracic Society (publishedVersion)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- GlaxoSmithKline
- European Commission (633212, HORIZON2020)
- University of Melbourne
- Helen Macpherson Smith Trust
- Medical Research Council
- National Health and Medical Research Council (1021275, 1101313, 299901 and 1021275, 299901)
- 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, chronic obstructive pulmonary disease, asthma, allergy, bronchitis, parental smoking, smoking, mediation, effect modification, latent class analysis, Tasmanian Longitudinal Health Study, FEV1, forced vital capacity
- MeSH terms
- Latent Class Analysis, Asthma, Bronchitis, Child, Female, Forced Expiratory Volume, Humans, Hypersensitivity, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, Tasmania, Tobacco Smoke Pollution, Vital Capacity, Pulmonary Disease, Chronic Obstructive
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