Lung function trajectories from pre-school age to adulthood and their associations with early life factors: a retrospective analysis of three population-based birth cohort studies

Danielle C M Belgrave, Raquel Granell, Steve W Turner, John A. Curtin, Iain E. Buchan, Peter N le Souëf, A John Henderson (Corresponding Author), Adnan Custovic

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Maximal lung function in early adulthood is an important determinant of mortality and COPD. We investigated whether distinct trajectories of lung function are present during childhood and whether these extend to adulthood and infancy.

To ascertain trajectories of FEV1, we studied two population-based birth cohorts (MAAS and ALSPAC) with repeat spirometry from childhood into early adulthood (1046 participants from 5–16 years and 1390 participants from 8–24 years). We used a third cohort (PIAF) with repeat lung function measures in infancy (V'maxFRC) and childhood (FEV1; 196 participants from 1 month to 18 years of age) to investigate whether these childhood trajectories extend from early life. We identified trajectories using latent profile modelling. We created an allele score to investigate genetic associations of trajectories, and constructed a multivariable model to identify their early-life predictors.

We identified four childhood FEV1 trajectories: persistently high, normal, below average, and persistently low. The persistently low trajectory (129 [5%] of 2436 participants) was associated with persistent wheezing and asthma throughout follow-up. In genetic analysis, compared with the normal trajectory, the pooled relative risk ratio per allele was 0·96 (95% CI 0·92–1·01; p=0·13) for persistently high, 1·01 (0·99–1·02; p=0·49) for below average, and 1·05 (0·98–1·13; p=0·13) for persistently low. Most children in the low V'maxFRC trajectory in infancy did not progress to the low FEV1 trajectory in childhood. Early-life factors associated with the persistently low trajectory included recurrent wheeze with severe wheezing exacerbations, early allergic sensitisation, and tobacco smoke exposure.

Reduction of childhood smoke exposure and minimisation of the risk of early-life sensitisation and wheezing exacerbations might reduce the risk of diminished lung function in early adulthood.
Original languageEnglish
Pages (from-to)526-534
Number of pages9
JournalThe Lancet. Respiratory medicine
Issue number7
Early online date5 Apr 2018
Publication statusPublished - Jul 2018

Bibliographical note

Funding: MAAS and STELAR cohorts are funded by the The UK Medical Research Council (MRC) Grants G0601361 and MR/K002449/1. The UK Medical Research Council and the Wellcome Trust (Grant ref:102215/2/13/2) and the University of Bristol provide core support for ALSPAC. ALSPAC lung function was funded by MRC grants G0401540 and MR/M022501/1. PIAF was funded by the National Health and
Medical Research Council of Australia. DB is supported by the MRC Career Development Award in Biostatistics Grant MR/M015181/1


  • respiratory function tests
  • forced expiratory volume
  • child development
  • lung diseases
  • obstructive
  • genetics


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