Combined Impact of Smoking and Early-Life Exposures on Adult Lung Function Trajectories

Both adverse early-life exposures and adult smoking can negatively influence adult lung function trajectory, but few studies consider how the impact of early-life exposures may be modified by subsequent smoking.

The Medical Research Council National Survey of Health and Development is a nationally representative cohort, initially of 5,362 individuals, followed since enrollment at birth in March 1946. Using data collected prospectively across life and multilevel modeling, we investigated how the relationships between early-life exposures (infant lower respiratory infection, manual social class, home overcrowding, and pollution exposure) and FEV₁ and FVC trajectories between ages 43 and 60-64 years were influenced by smoking behavior.

Among 2,172 individuals, there were synergistic interactions of smoking with infant respiratory infection (P = 0.04) and early-life home overcrowding (P = 0.009), for FEV₁ at 43 years. Within smoker-stratified models, there were FEV₁ deficits among ever-smokers associated with infant lower respiratory infection (-108.2 ml; P = 0.001) and home overcrowding (-89.2 ml; P = 0.002), which were not evident among never-smokers (-15.9 ml; P = 0.69 and -13.7 ml; P = 0.70, respectively). FVC modeling, including 1,960 individuals, yielded similar results. FEV₁ decline was greater in smokers (P < 0.001), but there was no effect of any early-life exposure on FEV₁ decline. Neither smoking nor early-life exposures were associated with FVC decline.

Besides accelerating adult FEV₁ decline, cigarette smoking also modifies how early-life exposures impact on both midlife FEV₁ and FVC. These findings are consistent with smoking impairing pulmonary development during adolescence or early adulthood, thereby preventing catch-up from earlier acquired deficits.