Early life origins of chronic obstructive pulmonary disease

Abstract

Background: Early life development may influence subsequent respiratory morbidity. The impact of factors determined in childhood on adult lung function, decline in lung function and chronic obstructive pulmonary disease (COPD) was investigated. Methods: European Community Respiratory Health Survey participants aged 20-45 years randomly selected from general populations in 29 centres underwent spirometry in 1991-3 (n = 13 359) and 9 years later (n = 7738). Associations of early life factors with adult forced expiratory volume in 1 s (FEV 1 ), FEV 1 decline and COPD (FEV 1 /FVC ratio ,70% and FEV 1 ,80% predicted) were analysed with generalised estimating equation models and random effects linear models. Results: Maternal asthma, paternal asthma, childhood asthma, maternal smoking and childhood respiratory infections were significantly associated with lower FEV 1 and defined as ''childhood disadvantage factors''; 40% had one or more childhood disadvantage factors which were associated with lower FEV 1 (men: adjusted difference 95 ml (95% CI 67 to 124); women: adjusted difference 60 ml (95% CI 40 to 80)). FEV 1 decreased with increasing number of childhood disadvantage factors (>3 factors, men: 274 ml (95% CI 154 to 395), women: 208 ml (95% CI 124 to 292)). Childhood disadvantage was associated with a larger FEV 1 decline (1 factor: 2.0 ml (95% CI 0.4 to 3.6) per year; 2 factors: 3.8 ml (95% CI 1.0 to 6.6); >3 factors: 2.2 ml (95% CI 24.8 to 9.2)). COPD increased with increasing childhood disadvantage (1 factor, men: OR 1.7 (95% CI 1.1 to 2.6), women: OR 1.6 (95% CI 1.01 to 2.6); >3 factors, men: OR 6.3 (95% CI 2.4 to 17), women: OR 7.2 (95% CI 2.8 to 19)). These findings were consistent between centres and when subjects with asthma were excluded. Conclusions: People with early life disadvantage have permanently lower lung function, no catch-up with age but a slightly larger decline in lung function and a substantially increased COPD risk. The impact of childhood disadvantage was as large as that of heavy smoking. Increased focus on the early life environment may contribute to the prevention of COPD.Early life environment is most important for the development of asthma and atopy, 1-3 but there has been less focus on early life origins of chronic obstructive pulmonary disease (COPD).1 4-6 The development of the bronchial tree is completed in terms of numbers of terminal bronchioles by the first trimester of pregnancy.7 The final number of alveoli is established by the age of 2 years. 7 8 Thereafter, growth and functional development of the bronchial tree and the alveoli continue until a plateau phase is reached by the end of adolescence in women 9 and in the mid-20s in men. 10 11 It seems plausible that this period of development and growth of the lungs might be important for lung function and the development of COPD later in life. 5While smoking is a very important determinant for adult lung function and COPD, there is a wide variation in adult lung function that is not related to smoking 12 and that could ...

Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease

“…[26][27][28][29] Svanes et al observed that childhood risk factors such as maternal smoking, childhood respiratory infections, and childhood asthma were strongly related to the development of COPD in young adults. 30 Nevertheless, although our results highlight the important role of maximally attained lung function in early adulthood, Shown is the distribution of observed annual decline in forced expiratory volume in 1 second (FEV 1 ) among 2864 participants in the Framingham Offspring Cohort (FOC) and the Copenhagen City Heart Study (CCHS), according to the four trajectories defined on the basis of a normal FEV 1 (≥80% of the predicted value) or low FEV 1 (<80% of the predicted value) at baseline and the presence or absence of chronic obstructive pulmonary disease (COPD) at the final examination. Participants were considered to have COPD if they had grade 2 or higher COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 grading system; grade 2 or higher COPD according to GOLD is defined as a ratio of FEV 1 to forced vital capacity of less than 0.70 and an FEV 1 of less than 80% of the predicted value, with the use of the prediction equations from the National Health and Nutrition Examination Survey for the FOC and local prediction equations for the CCHS.…”

A systematic review of early life factors which adversely affect subsequent lung function

“…The early life factors that have been implicated in poor future lung health include environmental tobacco smoke, antenatal nutrition, premature birth, respiratory infections in early life, air pollution, social deprivation, obesity and asthma. [5][6][7][8] To reduce the global burden of respiratory disease we should target modifiable early life factors known to be associated with subsequent respiratory disease.…”

Transient early wheeze and lung function in early childhood associated with chronic obstructive pulmonary disease genes

“…Several studies have shown that an early-life history of respiratory disease increases the mortality caused by COPD. 2,9 Especially the occurrence of transient early wheeze (TEW) in childhood can constitute a first sign of disturbed early lung development and lung growth because TEW has been shown to associate with reduced lung function already soon after birth, which is probably caused by genetic constitution, in utero exposures (eg, cigarette smoke), or both. 10 Furthermore, these airway developmental abnormalities related to TEW have been shown to associate with lower lung function when symptoms have disappeared, which then persists through the rest of childhood and adolescence.…”