Trajectories of airflow limitation from childhood to early adulthood: analysis of six population-based birth cohorts
File(s)
Published version
Author(s)
Ullah, Anhar
Type
Journal Article
Abstract
Background: Lung development during childhood is an important predictor of subsequent health and disease. Investigating developmental patterns of airflow limitation through childhood would help understand how different lung function trajectories relate to subsequent health and/or chronic airway disease.
Methods: Trajectories were derived using the latent class trajectory modelling of FEV1 and FEV1/FVC regression residuals ascertained in school-age (8–10 years), adolescence (15–18), and adulthood (20-26) in four cohorts (discovery, n=8,114) and replicated in two (n=1,337).
Findings: In the discovery populations we identified four trajectories: (1) Normal, n=6,555/8,114 (80.78%); (2) Persistent airflow obstruction, n=1,280/8,114 (15.78%); (3) Worsening airflow obstruction, n=161/8,114 (1.98%); and (4) Improved airflow obstruction, n=118/8,114 (1.45%). Improvement and worsening were observed from all obstruction severity levels and at both transitions (school-age→adolescence and adolescence→adulthood). Improvement was higher in the first, whereas worsening was higher in the second transition. Maternal smoking during pregnancy was associated with Persistent (relative risk ratio 1.25 [95%CI 1.15-1.36], p<0.001) and Worsening trajectories (1.32 [1.08-1.61], p=0.007). Higher body mass index (BMI) was associated with Persistent obstruction (1.13 [1.06-1.20], p<0.001). Participants in the Improvement trajectory had lower BMI and higher incidence of early wheezing, which then declined sharply from early childhood to adolescence. We observed a significant interaction between BMI and wheeze in school-age (pint=0.017); among current wheezers, higher BMI was associated with a lower relative risk of Improvement trajectory membership (0.69 [0.49-0.95], p<0.001]; in contrast, among non-wheezers, higher BMI increased the relative risk of Improvement trajectory membership (1.38 [1.04-1.85], p=0.002]. Results in replication cohorts were similar.
Interpretation: Worsening and improvement in airflow limitation from school-age to adulthood may occur at all ages and all airflow obstruction severity levels. Interventions to optimise healthy weight, including tackling overweight/obesity (particularly among children with wheezing), and underweight among non-wheezers may help improve lung health across the lifespan.
Funding. UK MRC grant MR/S025340/1; CADSET ERS Clinical Research Collaboration. CADSET has been supported by financial and other contributions from the following consortium partners: European Respiratory Society (ERS), AstraZeneca UK Ltd, Chiesi Farmaceutici, GlaxoSmithKline LLC, Menarini Group and Sanofi-Genzyme.
Methods: Trajectories were derived using the latent class trajectory modelling of FEV1 and FEV1/FVC regression residuals ascertained in school-age (8–10 years), adolescence (15–18), and adulthood (20-26) in four cohorts (discovery, n=8,114) and replicated in two (n=1,337).
Findings: In the discovery populations we identified four trajectories: (1) Normal, n=6,555/8,114 (80.78%); (2) Persistent airflow obstruction, n=1,280/8,114 (15.78%); (3) Worsening airflow obstruction, n=161/8,114 (1.98%); and (4) Improved airflow obstruction, n=118/8,114 (1.45%). Improvement and worsening were observed from all obstruction severity levels and at both transitions (school-age→adolescence and adolescence→adulthood). Improvement was higher in the first, whereas worsening was higher in the second transition. Maternal smoking during pregnancy was associated with Persistent (relative risk ratio 1.25 [95%CI 1.15-1.36], p<0.001) and Worsening trajectories (1.32 [1.08-1.61], p=0.007). Higher body mass index (BMI) was associated with Persistent obstruction (1.13 [1.06-1.20], p<0.001). Participants in the Improvement trajectory had lower BMI and higher incidence of early wheezing, which then declined sharply from early childhood to adolescence. We observed a significant interaction between BMI and wheeze in school-age (pint=0.017); among current wheezers, higher BMI was associated with a lower relative risk of Improvement trajectory membership (0.69 [0.49-0.95], p<0.001]; in contrast, among non-wheezers, higher BMI increased the relative risk of Improvement trajectory membership (1.38 [1.04-1.85], p=0.002]. Results in replication cohorts were similar.
Interpretation: Worsening and improvement in airflow limitation from school-age to adulthood may occur at all ages and all airflow obstruction severity levels. Interventions to optimise healthy weight, including tackling overweight/obesity (particularly among children with wheezing), and underweight among non-wheezers may help improve lung health across the lifespan.
Funding. UK MRC grant MR/S025340/1; CADSET ERS Clinical Research Collaboration. CADSET has been supported by financial and other contributions from the following consortium partners: European Respiratory Society (ERS), AstraZeneca UK Ltd, Chiesi Farmaceutici, GlaxoSmithKline LLC, Menarini Group and Sanofi-Genzyme.
Date Issued
2025-03-01
Date Acceptance
2025-01-02
Citation
The Lancet Child & Adolescent Health, 2025, 9 (3), pp.172-183
ISSN
2352-4642
Publisher
Elsevier
Start Page
172
End Page
183
Journal / Book Title
The Lancet Child & Adolescent Health
Volume
9
Issue
3
Copyright Statement
Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
License URL
Publication Status
Published
Date Publish Online
2025-02-18