Childhood maltreatment and lung function: findings from the general population

Abstract

ObjectiveCumulative evidence indicates that childhood maltreatment (CM) is linked to self-reported asthma and chronic obstructive pulmonary disease. However, the relation between CM and objective measures of lung function as determined by spirometry has not yet been assessed.MethodsMedical histories and spirometric lung function were taken in 1386 adults from the general population. Participants also completed the Childhood Trauma Questionnaire for the assessment of emotional, physical and sexual abuse as well as emotional and physical neglect.Results25.3% of the participants reported at least one type of CM. Among them, use of medication for obstructive airway diseases as well as typical signs and symptoms of airflow limitation were significantly more frequent than in the group without exposure to CM. Although participants with CM had numerically lower values for FEV1, FVC and PEF than those without, these differences were non-significant when accounting for relevant covariates like age, sex, height and smoking. Likewise, there were no differences in the FEV1/FVC ratio nor in the frequency of airflow limitation regardless of its definition. No specific type of CM was related to spirometrically determined parameters of lung function.ConclusionsOur findings call into question the association of CM with obstructive lung diseases as indicated by prior research relying on self-reported diagnoses. We consider several explanations for these discrepancies.

Child maltreatment and asthma

“…In contrast to findings for violence‐related distress in youth with asthma, there has been no or inconsistent association between child maltreatment and reduced lung function in studies of children 32 and adults 41,42 in the general population. In an Australian prospective cohort study of children followed from birth until age 21 years, child maltreatment was not associated with decrements in FVC, FEV 1 , or forced expiratory flow mid expiratory phase (FEF 25–75 ) 32 .…”

“…40 Taken together, those results suggest that increased violence-related distress between childhood and adolescence leads to reduced FEV 1 and FVC in subjects with asthma, and that this may be partly explained by reduced sensitivity to inhaled steroids. 40 In contrast to findings for violence-related distress in youth with asthma, there has been no or inconsistent association between child maltreatment and reduced lung function in studies of children 32 and adults 41,42 in the general population. In an Australian prospective cohort study of children followed from birth until age 21 years, child maltreatment was not associated with decrements in FVC, FEV 1 , or forced expiratory flow mid expiratory phase (FEF 25-75 ).…”

“…32 In a cross-sectional study of German adults older than 20 years, child maltreatment was significantly associated with asthma attacks, medication use for asthma, and asthma symptoms (e.g., wheeze without a cold), but not with FVC, FEV 1 , or FEV 1 /FVC. 41 However, only 1386 (32.2%) of the original 4308 study participants were included in the analysis, which was not adjusted for medication use or disease status (e.g., asthma or chronic obstructive pulmonary disease [COPD]). 41 In a case-control study nested within a prospective study, child maltreatment was defined as cases of physical abuse, sexual abuse, or neglect captured by the judicial system of an US mid-Western metropolitan area by age 11 years.…”

“…41 However, only 1386 (32.2%) of the original 4308 study participants were included in the analysis, which was not adjusted for medication use or disease status (e.g., asthma or chronic obstructive pulmonary disease [COPD]). 41 In a case-control study nested within a prospective study, child maltreatment was defined as cases of physical abuse, sexual abuse, or neglect captured by the judicial system of an US mid-Western metropolitan area by age 11 years. 42 After mean follow-up of ~30 years, neglect-but not physical or sexual abuse-was significantly associated with a reduced peak air flow, even after accounting for SES indicators, mental illness, smoking, and other covariates (aOR = 4.0, 95% CI = 1.1-15.3).…”

“…However, that study was limited by plausible selection bias due to substantial loss of follow‐up (~48%) and potential under‐reporting of child maltreatment (as only 3.5% of subjects had an event captured by a child protection agency) 32 . In a cross‐sectional study of German adults older than 20 years, child maltreatment was significantly associated with asthma attacks, medication use for asthma, and asthma symptoms (e.g., wheeze without a cold), but not with FVC, FEV 1 , or FEV 1 /FVC 41 . However, only 1386 (32.2%) of the original 4308 study participants were included in the analysis, which was not adjusted for medication use or disease status (e.g., asthma or chronic obstructive pulmonary disease [COPD]) 41 …”