Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life
Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life
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DOI：
10.1016/s2213-2600(18)30100-0
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发表时间：
2018-07-01
影响因子：
76.2
通讯作者：
Dharmage, Shyamali C.
中科院分区：
文献类型：
--
作者：
Bui, Dinh S.;Lodge, Caroline J.;Dharmage, Shyamali C.
背景 终生肺功能与生活质量和寿命有关。在一生中，个体遵循不同的肺功能轨迹。识别这些轨迹、其决定因素和结果很重要，但没有研究在第四个十年之后做到这一点。 方法我们使用塔斯马尼亚纵向健康研究 (TAHS) 的六波来模拟 7、13、18、45、50 和 53 年测量的肺功能轨迹。我们使用基于组的轨迹模型分析了六个时间点的支气管扩张前 FENT、z 评分，以识别随着时间的推移测量结果遵循相似模式的个体的不同亚组。我们使用逻辑回归将确定的轨迹与儿童期因素和慢性阻塞性肺病 (COPD) 风险联系起来，并估计了 COPD 的人群归因分数。结果 在原始队列的 8583 名参与者中，2438 名参与者在 7 岁和 53 岁时至少有两波肺功能数据，他们构成了研究人群。我们确定了六种轨迹：早期低于平均水平，加速下降（97 [4%] 参与者）；持续较低（136 [6%] 参与者）；早期低点、加速增长、正常下降（196 [8%] 参与者）；持续高位（293 [12%] 参与者）；低于平均水平（772 [32%] 参与者）；和平均水平（944 [39%] 参与者）。三大轨迹前期低于平均水平，加速下跌；持续低位；与平均组相比，低于平均水平的人在 53 岁时患 COPD 的风险增加（早期低于平均水平，加速下降：优势比 35.0，95% CI 19.5-64.0；持续较低：9.5，4.5-20.6；低于平均水平：3.7，1.9-6.9）。这三种轨迹的早期预测因素包括儿童哮喘、支气管炎、肺炎、过敏性鼻炎、湿疹、父母哮喘和母亲吸烟。个人吸烟和活跃的成人哮喘分别增加了母亲吸烟和儿童哮喘的影响，在早期低于平均水平，加速下降轨迹。解释我们确定了六种潜在的 FENT 轨迹，其中两种是新颖的。三种轨迹占 COPD 负担的 75%，并且与可改变的早期暴露相关，其影响因成人因素而加剧。我们假设，减少母亲吸烟、鼓励免疫接种和避免个人吸烟，尤其是那些父母吸烟或儿童肺功能低下的人，可能会最大限度地降低慢性阻塞性肺病的风险。应让临床医生和哮喘患者意识到非最佳哮喘控制对终生肺功能轨迹的潜在长期影响，并应在未来的干预试验中研究最佳哮喘控制对改善肺功能的作用和益处。
Background Lifetime lung function is related to quality of life and longevity. Over the lifespan, individuals follow different lung function trajectories. Identification of these trajectories, their determinants, and outcomes is important, but no study has done this beyond the fourth decade.Methods We used six waves of the Tasmanian Longitudinal Health Study (TAHS) to model lung function trajectories measured at 7,13,18,45,50, and 53 years. We analysed pre-bronchodilator FENT, z-scores at the six timepoints using group-based trajectory modelling to identify distinct subgroups of individuals whose measurements followed a similar pattern over time. We related the trajectories identified to childhood factors and risk of chronic obstructive pulmonary disease (COPD) using logistic regression, and estimated population-attributable fractions of COPD.Findings Of the 8583 participants in the original cohort, 2438 had at least two waves of lung function data at age 7 years and 53 years and comprised the study population. We identified six trajectories: early below average, accelerated decline (97 [4%] participants); persistently low (136 [6%] participants); early low, accelerated growth, normal decline (196 [8%] participants); persistently high (293 [12%] participants); below average (772 [32%] participants); and average (944 [39%] participants). The three trajectories early below average, accelerated decline; persistently low; and below average had increased risk of COPD at age 53 years compared with the average group (early below average, accelerated decline: odds ratio 35.0, 95% CI 19.5-64.0; persistently low: 9.5, 4.5-20.6; and below average: 3.7, 1.9-6.9). Early-life predictors of the three trajectories included childhood asthma, bronchitis, pneumonia, allergic rhinitis, eczema, parental asthma, and maternal smoking. Personal smoking and active adult asthma increased the impact of maternal smoking and childhood asthma, respectively, on the early below average, accelerated decline trajectory.Interpretation We identified six potential FENT, trajectories, two of which were novel. Three trajectories contributed 75% of COPD burden and were associated with modifiable early-life exposures whose impact was aggravated by adult factors. We postulate that reducing maternal smoking, encouraging immunisation, and avoiding personal smoking, especially in those with smoking parents or low childhood lung function, might minimise COPD risk. Clinicians and patients with asthma should be made aware of the potential long-term implications of non-optimal asthma control for lung function trajectory throughout life, and the role and benefit of optimal asthma control on improving lung function should be investigated in future intervention trials.