Childhood Lung Function Predicts Adult Chronic Obstructive Pulmonary Disease and Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome

Am J Respir Crit Care Med. 2017 Jul 1;196(1):39-46. doi: 10.1164/rccm.201606-1272OC.


Rationale: The burden of chronic obstructive pulmonary disease (COPD) is increasing, yet there are limited data on early life risk factors.

Objectives: To investigate the role of childhood lung function in adult COPD phenotypes.

Methods: Prebronchodilator spirometry was performed for a cohort of 7-year-old Tasmanian children (n = 8,583) in 1968 who were resurveyed at 45 years, and a selected subsample (n = 1,389) underwent prebronchodilator and post-bronchodilator spirometry. For this analysis, COPD was spirometrically defined as a post-bronchodilator FEV1/FVC less than the lower limit of normal. Asthma-COPD overlap syndrome (ACOS) was defined as the coexistence of both COPD and current asthma. Associations between childhood lung function and asthma/COPD/ACOS were examined using multinomial regression.

Measurements and main results: At 45 years, 959 participants had neither current asthma nor COPD (unaffected), 269 had current asthma alone, 59 had COPD alone, and 68 had ACOS. The reweighted prevalence of asthma alone was 13.5%, COPD alone 4.1%, and ACOS 2.9%. The lowest quartile of FEV1 at 7 years was associated with ACOS (odds ratio, 2.93; 95% confidence interval, 1.32-6.52), but not COPD or asthma alone. The lowest quartile of FEV1/FVC ratio at 7 years was associated with ACOS (odds ratio, 16.3; 95% confidence interval, 4.7-55.9) and COPD (odds ratio, 5.76; 95% confidence interval, 1.9-17.4), but not asthma alone.

Conclusions: Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention. Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function.

Keywords: asthma–COPD overlap syndrome; childhood lung function; early life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma / physiopathology*
  • Child
  • Female
  • Forced Expiratory Volume
  • Humans
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Respiratory Function Tests / statistics & numerical data
  • Risk Factors
  • Spirometry / statistics & numerical data
  • Syndrome
  • Tasmania
  • Vital Capacity