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Respiratory epidemiology
Original research
Distinct trajectories of lung function from childhood to mid-adulthood
  1. Xian Zhang1,2,
  2. Andrew R Gray3,
  3. Robert J Hancox1
  1. 1Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
  2. 2National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
  1. Correspondence to Prof Robert J Hancox, Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand; bob.hancox{at}otago.ac.nz

Abstract

Rationale Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented.

Objective To document lung function trajectories from childhood to mid-adult life.

Methods We modelled forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based cohort using latent profile analysis to identify distinct subgroups of participants with similar lung function trajectories. Regression analyses were used to assess associations between the trajectories, early life factors and postbronchodilator airflow obstruction at age 45.

Results Among 865 participants with ≥6 measures of lung function, we identified 10 distinct FEV1 trajectories. Most were approximately parallel except for a childhood airway hyper-responsiveness-related persistently low trajectory (3% of study population); two accelerated-decline trajectories, one of which (8%) was associated with smoking and higher adult body mass index (BMI) and a catch-up trajectory (8%). Findings for FEV1/FVC trajectories were similar. Nine trajectories were identified for FVC: most were also approximately parallel except for a higher BMI-related accelerated-decline trajectory. The three FEV1 trajectories leading to the lowest FEV1 values comprised 19% of the cohort but contributed 55% of airflow obstruction at age 45.

Conclusions Lung function trajectories to mid-adult life are largely established before adolescence, with a few exceptions: a childhood airway hyper-responsiveness-related persistently low trajectory, which starts low and gets worse with age, and accelerated adult decline trajectories associated with smoking and obesity. Adverse trajectories are associated with a high risk of airflow obstruction in mid-adult life.

  • Lung Physiology
  • Asthma Epidemiology
  • COPD epidemiology

Data availability statement

Data are available on reasonable request. We do not have ethical approval to make the data publicly available. Deidentified data may be available to researchers on reasonable request subject to an approved research proposal.

https://doi.org/10.1136/thorax-2023-220436

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    Data availability statement

    Data are available on reasonable request. We do not have ethical approval to make the data publicly available. Deidentified data may be available to researchers on reasonable request subject to an approved research proposal.

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    Footnotes

    • Contributors All authors contributed to the study concept and design. RJH acquired data. XZ and ARG conducted the statistical analysis. RJH, ARG and XZ interpreted the data. XZ drafted the manuscript. All authors critically revised the manuscript for important intellectual content. RJH is the guarantor of the paper.

    • Funding The Dunedin Multidisciplinary Health and Development Research Unit is funded by the Health Research Council of New Zealand (programme grant 16-604) and has also received funding from the New Zealand Ministry of Business, Innovation and Employment (no award number). This research was also supported by UK MRC grant MR/P005918/1 and US-National Institute of Aging grants R01AG032282 and R01AG069936.

    • Disclaimer The funders played no role in the conduct of the study or the decision to publish the findings.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.