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Acute lower respiratory illness in childhood as a predictor of lung function and chronic respiratory symptoms
D R Gold1, I B Tager, S T Weiss
1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
Insights
Early and recurrent acute lower respiratory illness (LRI) in children significantly impairs lung function development, particularly in boys. This highlights the long-term impact of childhood respiratory infections on lung health.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Epidemiology
Background:
- Childhood acute lower respiratory illness (LRI) can have lasting effects on lung function.
- Understanding the long-term impact of LRI on lung development is crucial for early intervention.
Purpose of the Study:
- To investigate the relationship between acute LRI and lung function (FEF25-75, FEV1) in a pediatric cohort.
- To assess the impact of early-life respiratory illness and recurrent LRI on lung function trajectories.
- To examine sex-based differences in the effects of LRI on lung function.
Main Methods:
- Longitudinal cohort study of 801 children followed for up to 13 years.
- Analysis of the association between acute lower respiratory illness (LRI) and forced expiratory volumes (FEF25-75, FEV1).
- Inclusion of factors like early-life respiratory illness, recurrent LRI, pneumonia, and hospitalization in the analysis.
Main Results:
- Co-occurrence of early illness and recurrent LRI was linked to significantly lower mean FEF25-75 levels and reduced longitudinal change.
- The negative impact of LRI on lung function was more pronounced in boys than in girls.
- Pneumonia and/or hospitalization for respiratory illness before the study were associated with lower cross-sectional FEV1 and slower FEV1 increase over time, even in non-asthmatic children.
Conclusions:
- Acute LRI, especially when occurring early in life or recurrently, has a detrimental and lasting effect on pediatric lung function.
- Boys appear more susceptible to the long-term pulmonary consequences of LRI.
- Previous severe respiratory events like pneumonia or hospitalization predict poorer lung function development in children.
Abstract:
This study investigated the relationship of acute lower respiratory illness (LRI) to level and change in level of forced expiratory volumes in a cohort of 801 children, followed longitudinally for a maximum of 13 yr. The co-occurrence of respiratory illness before 2 yr of age and two or more LRI during a single surveillance year was associated with a 20.3% lower mean cross-sectional level of FEF25-75, and with reduced longitudinal change in level of FEF25-75. The effect of LRI on lung function was uniformly stronger for boys than for girls. Of the children with illness before 2 yr of age and two or more LRI, six of 14 were male asthmatics with mean levels of FEF25-75 that were lower than those of other asthmatic children. Pneumonia and/or hospitalization for respiratory illness prior to the onset of study were associated with lower cross-sectional levels of forced expiratory volumes at entry to the study, even when asthmatics/persistent wheezers were eliminated from the analysis (6.1% lower level of FEV1 for a nonasthmatic boy with previous hospitalization versus a nonasthmatic boy without hospitalization). In the longitudinal analysis, pneumonia and/or hospitalization were associated with slower increase in level of forced expiratory volumes, even after adjusting for "ever diagnosis of asthma/current any wheeze" (starting at the same leve, after eight years a boy with hospitalization would develop a 5.0% lower FEV1 than a boy without hospitalization). Acute LRI also was evaluated as a predictor of chronic respiratory symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)