Childhood lung function is associated with adolescent-onset and persistent asthma

Hans Jacob L Koefoed; Anhar Ullah; Jenny Hallberg; Simon Kebede Merid; Maura M Kere; Lesley Lowe; Angela Simpson; Clare S Murray; Ulrike Gehring; Roel Vermeulen; Inger Kull; Anna Bergström; Judith M Vonk; Adnan Custovic; Erik Melén; Gerard H Koppelman

doi:10.1183/23120541.00469-2024

Childhood lung function is associated with adolescent-onset and persistent asthma

ERJ Open Res. 2024 Dec 9;10(6):00469-2024. doi: 10.1183/23120541.00469-2024. eCollection 2024 Nov.

Authors

Hans Jacob L Koefoed^{1

2

3}, Anhar Ullah⁴, Jenny Hallberg^{3

5}, Simon Kebede Merid³, Maura M Kere³, Lesley Lowe^{6

7}, Angela Simpson^{6

7}, Clare S Murray^{6

7}, Ulrike Gehring⁸, Roel Vermeulen⁸, Inger Kull³, Anna Bergström^{9

10}, Judith M Vonk^{2

11}, Adnan Custovic⁴, Erik Melén^{3

5}, Gerard H Koppelman^{1

2}

Affiliations

¹ University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, the Netherlands.
² University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands.
³ Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
⁴ National Heart and Lung Institute, Imperial College London, London, UK.
⁵ Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
⁶ Division of Immunology, Immunity to infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
⁷ Manchester University NHS Foundation Trust, Manchester, UK.
⁸ Institute of Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
⁹ Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden.
¹⁰ Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
¹¹ University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.

Abstract

Background: Asthma is associated with impaired lung function; however, it is uncertain if a lower childhood lung function is associated with asthma onset and persistence during adolescence. The aims of the present study were to investigate the association between childhood lung function and onset and persistence of asthma during adolescence.

Methods: In the population-based BAMSE (Sweden), PIAMA (Netherlands) and MAAS (UK) birth cohorts, we analysed the association of forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), FEV₁/FVC and forced expiratory volume at 75% of FVC at age 8 years with asthma onset and persistence in adolescence (age 12-16 years) using cohort-specific logistic regression analysis followed by meta-analysis.

Results: In the BAMSE, PIAMA and MAAS cohorts, asthma incidence in adolescence was 6.1% (112/1824), 3.4% (36/1050) and 5.0% (39/779), respectively. Persistent asthma from childhood to adolescence was observed in 8.2%, 6.4% and 7.7% of all subjects within the respective cohorts. A higher FEV₁ % predicted and FEV₁/FVC at age 8 years was associated with a lower odds for adolescent-onset asthma: OR 0.98 (95% CI 0.97-1.00) and 0.97 (0.94-0.99). These associations remained significant also when restricting the analyses to subjects with no wheezing or asthma treatment in childhood. A higher FEV₁/FVC at age 8 years was associated with a lower odds for asthma persistence in adolescence (0.96 (0.93-0.99)). Sex by lung function interaction analysis was not significant.

Conclusions: A higher lung function at school age was associated with a lower risk of adolescent-onset asthma, predominantly in males. This indicates that a lower lung function in childhood may precede and or potentially contribute to asthma incidence and persistence.