Childhood Respiratory Risk Factor Profiles and Middle-Age Lung Function: A Prospective Cohort Study from the First to Sixth Decade

Abstract

Word count: 3499 AT A GLANCE COMMENTARY Scientific Knowledge on the SubjectChildhood factors may have long-term implications for adult lung function and development of Chronic Obstructive Pulmonary Disease (COPD). A systematic approach to investigating profiles of childhood respiratory risk factors as predictors of middle-age lung function and risk of COPD, and their pathways has not been previously undertaken. What This Study Adds to the FieldUsing an objective categorizing approach to establish patterns, we identified distinct childhood respiratory risk profiles in a large cohort. We found that specific risk profiles have different effects on middle-age lung function and COPD and that their effects have different pathways. Children with frequent asthma attacks and multiple allergies were found to be most at risk of developing COPD and lung function deficits in middle-age. This link was largely transmitted through active asthma in adulthood and to a lesser degree through reduced lung function in childhood. This highlights the importance of lifetime asthma control. The finding that subsequent personal smoking markedly increased the long-term risk for some risk profiles highlights an opportunity for targeted prevention. Our findings suggest that childhood risk factor profiles are useful to predict long-term lung health.This article has an online data supplement, which is accessible from this issue's table of content online at www.atsjournals.org 1 Abstract Rationale:Childhood risk factors for long-term lung health often co-exist and their specific patterns may affect subsequent lung function differently. Objectives:To identify childhood risk factor profiles, 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 8352 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 FEV1: (-261; 95%CI: -373,-148 mL); lower FEV1/FVC: (-3.4; -4.8,-1.9%) and increased COPD risk (OR: 4.9; 2.1,11.0) 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 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 ...

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