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Spirometric phenotypes from early childhood to young adulthood: a Chronic Airway Disease Early Stratification study
Gang Wang1,2,3, Jenny Hallberg2,4,3, Dimitrios Charalampopoulos5
1Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China.
Insights
Childhood respiratory phenotypes, obstructive and restrictive, are common and linked to early life factors. Obstructive types associate with asthma, preterm birth, and smoking, while restrictive types link to lower BMI, indicating different origins.
Area of Science:
- Pulmonology
- Pediatric Respiratory Medicine
- Epidemiology
Background:
- Prevalence and early-life risk factors for obstructive and restrictive spirometric phenotypes are not well understood.
- Understanding these phenotypes is crucial for early diagnosis and intervention in respiratory diseases.
Purpose of the Study:
- To investigate the prevalence of obstructive and restrictive spirometric phenotypes in European cohorts.
- To explore associations between these phenotypes and known respiratory risk factors from childhood to young adulthood.
Main Methods:
- Analysis of 49,334 participants across 14 European population-based cohorts.
- Phenotypes defined using forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) z-scores relative to lower limit of normal (LLN).
- Age groups analyzed: ≤10, >10-15, >15-20, >20-25 years, and overall (5-25 years).
Main Results:
- Obstructive phenotype prevalence ranged from 3.2-10.9%; restrictive from 1.8-7.7%, with no clear age trends.
- Asthma diagnosis, preterm birth, maternal smoking, and family history of asthma associated with obstructive phenotype.
- Higher BMI linked to obstructive phenotype; lower BMI linked to restrictive phenotype. Current smoking associated with obstructive phenotype in those >10 years.
Conclusions:
- Obstructive and restrictive spirometric phenotypes are prevalent in childhood, supporting the concept of early origins.
- Distinct risk factor associations (e.g., asthma, BMI) suggest different underlying pathobiology for obstructive and restrictive phenotypes.
- Findings highlight the importance of early-life factors in shaping respiratory health trajectories.
Background:
The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts.
Methods:
We studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10-15, >15-20, >20-25 years, and overall, 5-25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV1/FVC z-score ≥LLN, and FVC z-score
Results:
The prevalence of obstructive and restrictive phenotypes varied from 3.2-10.9% and 1.8-7.7%, respectively, without clear age trends. A diagnosis of asthma (adjusted odds ratio (aOR=2.55, 95% CI 2.14-3.04), preterm birth (aOR=1.84, 1.27-2.66), maternal smoking during pregnancy (aOR=1.16, 95% CI 1.01-1.35) and family history of asthma (aOR=1.44, 95% CI 1.25-1.66) were associated with a higher prevalence of obstructive, but not restrictive, phenotype across ages (5-25 years). A higher current body mass index (BMI was more often observed in those with the obstructive phenotype but less in those with the restrictive phenotype (aOR=1.05, 95% CI 1.03-1.06 and aOR=0.81, 95% CI 0.78-0.85, per kg·m-2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24, 95% CI 1.05-1.46).
Conclusion:
Obstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with the obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes.
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