Evolution of Lung Function within Individuals: Clinical Insights and Data-driven Methods

Understanding the heterogeneity of childhood allergic sensitization and its relationship with asthma

“…To tackle these issues, substantial effort has been devoted over the last 15 years to understanding the heterogeneity of childhood atopic diseases using modern data approaches (reviewed in [23 ▪▪ ,24–27]). These data-driven analyses have revealed hidden/unobservable (latent) structures in the large longitudinal datasets from birth cohort studies; especially noteworthily, the methods have now described different clusters of wheeze/asthma [5,28 ▪ ,29 ▪ ] (reviewed recently in [23 ▪▪ ,30,31]), allergic multimorbidity [32 ▪ ], rhinitis [33], eczema [34 ▪ ,35] and lung function [36,37 ▪ ,38,39 ▪ ]. Important questions which still need to be answered are: (1) whether different clusters of asthma and atopic disease are mechanistically different diseases which are underpinned by different pathophysiological mechanisms [40]; and (2) in the context of this review, whether they differ in their associations with allergic sensitization.…”

Understanding progression from pre‐school wheezing to school‐age asthma: Can modern data approaches help?

“…Irrespective of the uncertainties outlined above, one key point must be emphasized: all clusters/phenotypes of preschool wheezing (even the transient ones) are associated with impaired lung function in early adulthood. 46,50 Given the body of evidence that diminished lung function at a person's physiological peak in the third decade of life is associated with adverse health outcomes throughout their life-course 52 -including poor respiratory health and higher risk of COPD, 53 cardiovascular and cerebrovascular events into middle age, 54 sudden cardiac death 55 and premature death of all causes 56 and that impaired spirometry in adulthood is associated with subnormal lung function trajectories through childhood, 57,58 we need to pursue research to understand the mechanisms of not only persistent wheezing, but all childhood wheeze phenotypes. 59,60 However, these symptom-based labels are of limited value.…”

Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies

“… 5 Overall evidence to date suggests that impaired spirometry in adulthood is associated with subnormal lung function trajectories through childhood. 6 Therefore, understanding the factors associated with decline and improvement in lung function through childhood is important and may facilitate development of interventions to preserve or improve lung function and prevent subsequent onset and progression of ill health.…”

“…Some previous studies have described “catch-up” and “growth failure” in specific spirometric measures of lung function, 11 providing evidence that within-individual changes over time (such as improvement and worsening) do occur. 6 However, to date, no studies have investigated longitudinal development and transitions between obstructive and restrictive spirometry phenotypes, including worsening and improvement. Filling this knowledge gap could provide insights into the early origins and transition behavior of these lung function phenotypes from childhood into adulthood and identify actionable targets to promote improvement and reduce worsening.…”