Childhood lung function predicts adult chronic obstructive pulmonary disease and asthma-chronic obstructive pulmonary disease overlap syndrome

Dinh S. Bui, John A Burgess, Adrian J. Lowe, Jennifer L. Perret, Caroline J Lodge, Minh Bui, Stephen Morrison, Bruce R. Thompson, Paul S. Thomas, Graham G. Giles, Judith Garcia-Aymerich, Debbie Jarvis, Michael J. Abramson, E. Haydn Walters, Melanie C. Matheson, Shyamali C. Dharmage

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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,59hadCOPDalone, and68hadACOS.The reweightedprevalence 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 notCOPDor 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), butnot asthma alone. Conclusions: Being inthe lowest quartile for lungfunction at age 7may have long-term consequences for the development of COPDand 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 possiblemodifiers of these associations and develop interventions for children with impaired lung function.

Original languageEnglish
Pages (from-to)39-46
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number1
Publication statusPublished - 1 Jul 2017


  • Asthma-COPD overlap syndrome
  • Childhood lung function
  • Early life

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