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Childhood antecedents of adult respiratory disease
1Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia.
Insights
Early childhood respiratory symptoms are often transient, but persistent issues may indicate future adult respiratory disease. Longitudinal studies highlight atopy and smoke exposure as key risk factors.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Genetics
Background:
- Investigating the link between early childhood respiratory symptoms and adult respiratory disease is complex.
- Retrospective studies often suffer from inaccurate diagnoses of early childhood respiratory symptoms.
Purpose of the Study:
- To review the relationship between early childhood lower respiratory symptoms and adult respiratory disease.
- To identify risk factors for the development and persistence of childhood respiratory problems into adulthood.
Main Methods:
- Emphasis on longitudinal studies (including those from birth) with strict diagnostic criteria for respiratory episodes.
- Analysis of evidence from cross-sectional and longitudinal investigations.
- Discussion of genetic markers and their role.
Main Results:
- Most infant wheezing is transient, linked to small airways.
- Persistent respiratory symptoms into later childhood are associated with atopy.
- Cigarette smoke exposure is a significant risk factor for abnormal lung development and reduced lung function.
Conclusions:
- Longitudinal data suggest most early childhood respiratory symptoms do not predict adult disease, but persistence indicates risk.
- Atopy and environmental factors like smoke exposure are crucial.
- Genetic markers will enhance future research into childhood antecedents of adult respiratory disease.
Abstract:
This review examines the relations between early childhood lower respiratory symptoms and adult respiratory disease. The problems associated with investigating potential associations between respiratory disease in children and adults are discussed. Some studies have limitations because they are retrospective and early childhood respiratory symptoms have not been accurately diagnosed. Therefore, in this review, particular attention is paid to longitudinal studies (some from birth) that have used strict diagnostic criteria for respiratory episodes. These studies provide unique insights into the risk factors for the development of childhood respiratory problems and for persistence of symptoms into adulthood. Although cross-sectional studies have indicated that early childhood respiratory disease is more frequent in adults with respiratory disease, evidence from longitudinal studies suggests that respiratory symptoms such as wheezing, are transient in the majority of infants and result from developmentally small airways. These longitudinal investigations have also indicated that persistence of symptoms into later childhood is associated with atopy. The important role of cigarette-smoke exposure as a risk factor for abnormal pulmonary development, persistence of respiratory disease and reduction in lung function is discussed. The discovery of genetic markers associated with respiratory syndromes such as asthma, should facilitate studies that investigate the childhood antecedents of adult respiratory disease. Future longitudinal studies using genetic markers, will allow relations between specific genotypes and phenotypic outcomes to be examined.