Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies
Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies
Background: Spirometric obstruction and restriction are two patterns of impaired lung function which are predictive of poor health. We investigated the development of these phenotypes and their transitions through childhood to early adulthood. Methods: In this study, we analysed pooled data from three UK population−based birth cohorts established between 1989 and 1995. We applied descriptive statistics, regression modelling and data-driven modelling to data from three population−based birth cohorts with at least three spirometry measures from childhood to adulthood (mid-school: 8–10 years, n = 8404; adolescence: 15–18, n = 5764; and early adulthood: 20–26, n = 4680). Participants were assigned to normal, restrictive, and obstructive spirometry based on adjusted regression residuals. We considered two transitions: from 8–10 to 15–18 and from 15–18 to 20–26 years. Findings: Obstructive phenotype was observed in ∼10%, and restrictive in ∼9%. A substantial proportion of children with impaired lung function in school age (between one third in obstructive and a half in restricted phenotype) improved and achieved normal and stable lung function to early adulthood. Of those with normal lung function in school-age, <5% declined to adulthood. Underweight restrictive and obese obstructive participants were less likely to transit to normal. Maternal smoking during pregnancy and current asthma diagnosis increased the risk of persistent obstruction and worsening. Significant associate of worsening in restrictive phenotypes was lower BMI at the first lung function assessment. Data-driven methodologies identified similar risk factors for obstructive and restrictive clusters. Interpretation: The worsening and improvement in obstructive and restrictive spirometry were observed at all ages. Maintaining optimal weight during childhood and reducing maternal smoking during pregnancy may reduce spirometry obstruction and restriction and improve lung function. Funding: MRC Grant MR/S025340/1.
Improvement, Lung function, Obstruction, Restriction, Worsening
102355
Ullah, Anhar
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Granell, Raquel
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Haider, Sadia
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Lowe, Lesley
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Fontanella, Sara
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Arshad, Hasan
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Murray, Clare S.
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Turner, Steve
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Holloway, John W.
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Simpson, Angela
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Roberts, Graham
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Custovic, Adnan
17d8d092-73b8-44fb-bf48-5cea7b29e3fc
on behalf of STELAR/UNICORN Investigators
January 2024
Ullah, Anhar
4b6238e0-975f-48bb-8b05-eb45c2b210e1
Granell, Raquel
06e9e006-3754-4cc9-b3fc-42024bd05123
Haider, Sadia
ed3296e0-288d-49b1-befb-fe4545a7278e
Lowe, Lesley
57e2168b-e46e-4f76-bd55-12729ba740be
Fontanella, Sara
6c29b69f-edd6-4414-a8fd-c47241976aa5
Arshad, Hasan
917e246d-2e60-472f-8d30-94b01ef28958
Murray, Clare S.
aca69df6-149c-401c-842f-5b2d8042edf1
Turner, Steve
5ece7027-a2ba-4cd7-a710-6f4b823dba9a
Holloway, John W.
4bbd77e6-c095-445d-a36b-a50a72f6fe1a
Simpson, Angela
5591f945-0ead-46a3-a866-b7bea84a2a83
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Custovic, Adnan
17d8d092-73b8-44fb-bf48-5cea7b29e3fc
Ullah, Anhar, Granell, Raquel, Haider, Sadia, Lowe, Lesley, Fontanella, Sara, Arshad, Hasan, Murray, Clare S., Turner, Steve, Holloway, John W., Simpson, Angela, Roberts, Graham and Custovic, Adnan
,
on behalf of STELAR/UNICORN Investigators
(2024)
Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies.
EClinicalMedicine, 67, , [102355].
(doi:10.1016/j.eclinm.2023.102355).
Abstract
Background: Spirometric obstruction and restriction are two patterns of impaired lung function which are predictive of poor health. We investigated the development of these phenotypes and their transitions through childhood to early adulthood. Methods: In this study, we analysed pooled data from three UK population−based birth cohorts established between 1989 and 1995. We applied descriptive statistics, regression modelling and data-driven modelling to data from three population−based birth cohorts with at least three spirometry measures from childhood to adulthood (mid-school: 8–10 years, n = 8404; adolescence: 15–18, n = 5764; and early adulthood: 20–26, n = 4680). Participants were assigned to normal, restrictive, and obstructive spirometry based on adjusted regression residuals. We considered two transitions: from 8–10 to 15–18 and from 15–18 to 20–26 years. Findings: Obstructive phenotype was observed in ∼10%, and restrictive in ∼9%. A substantial proportion of children with impaired lung function in school age (between one third in obstructive and a half in restricted phenotype) improved and achieved normal and stable lung function to early adulthood. Of those with normal lung function in school-age, <5% declined to adulthood. Underweight restrictive and obese obstructive participants were less likely to transit to normal. Maternal smoking during pregnancy and current asthma diagnosis increased the risk of persistent obstruction and worsening. Significant associate of worsening in restrictive phenotypes was lower BMI at the first lung function assessment. Data-driven methodologies identified similar risk factors for obstructive and restrictive clusters. Interpretation: The worsening and improvement in obstructive and restrictive spirometry were observed at all ages. Maintaining optimal weight during childhood and reducing maternal smoking during pregnancy may reduce spirometry obstruction and restriction and improve lung function. Funding: MRC Grant MR/S025340/1.
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Accepted/In Press date: 21 November 2023
e-pub ahead of print date: 12 December 2023
Published date: January 2024
Additional Information:
Funding Information:
Supported by the UK Medical Research Council (UK MRC) Programme grant MR/S025340/1 , and grants G0601361 and MR/K002449/1 . R.G. was in part funded through Wellcome Trust Strategic Award 108818/15/Z . The UK MRC and Wellcome (grant ref: 217065/Z/19/Z ) and the University of Bristol provide core support for ALSPAC (Avon Longitudinal Study of Parents and Children). MAAS (Manchester Asthma and Allergy Study) was supported by the Asthma UK Grants No 301 (1995–1998), No 362 (1998–2001), No 01/012 (2001–2004), No 04/014 (2004–2007), British Medical Association James Trust (2005), and the JP Moulton Charitable Foundation (2004–2016), the North West Lung Centre Charity (1997–current), and the UK MRC grant MR/L012693/1 (2014–2018). The Isle of Wight Birth Cohort assessments have been supported by National Institutes of Health , USA (grant number R01 HL082925 ), Asthma UK (grant number 364 ), British Medical Association James Trust grant and the David Hide Asthma and Allergy Research Trust . This research was in part supported by the NIHR Imperial Biomedical Research Centre (BRC) and Manchester BRC . The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Funding sources had no role any in aspect pertinent to the study (including data collection, analysis, interpretation, design, participant recruitment etc.). Authors were not precluded from accessing data in the study, and all authors accept responsibility to submit for publication.
Publisher Copyright:
© 2023 The Author(s)
Keywords:
Improvement, Lung function, Obstruction, Restriction, Worsening
Identifiers
Local EPrints ID: 485715
URI: http://eprints.soton.ac.uk/id/eprint/485715
ISSN: 2589-5370
PURE UUID: f78c0fca-b8d9-4516-9ed9-99f253e90a63
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Date deposited: 15 Dec 2023 17:33
Last modified: 18 Mar 2024 03:01
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Contributors
Author:
Anhar Ullah
Author:
Raquel Granell
Author:
Sadia Haider
Author:
Lesley Lowe
Author:
Sara Fontanella
Author:
Clare S. Murray
Author:
Steve Turner
Author:
Angela Simpson
Author:
Adnan Custovic
Corporate Author: on behalf of STELAR/UNICORN Investigators
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