PURPOSE OF THE STUDY.
To investigate whether diminished lung function observed in children with early lower respiratory illnesses (LRIs) including pneumonia tends to persist into adulthood.
Children enrolled in the prospective Tucson Children’s Respiratory Study cohort (N = 1246).
The presence of early-life LRIs (during the first 3 years of life) was documented by pediatricians. Spirometry was measured at 11, 16, 22, and 26 years of age. Clinical evidence for wheeze or active asthma in the previous years was also assessed at 11, 13, 16, 18, 22, 24, 26, and 29 years. Longitudinal random effects models and generalized estimating equations were used to assess the relationship of LRIs to lung function and asthma.
Compared with children without early life LRIs, those with early pneumonia had the most severe subsequent lung function impairment: mean prebronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FEV1/FVC) deficits of –3.9% ± 0.9% and mean postbronchodilator FEV1/FVC deficits of –2.5% ± 0.8% from age 11 to 26 years. Early-life pneumonia was associated with increased risk for asthma (odds ratio [OR] 1.95, 95% confidence interval [CI]: 1.11–3.44) and wheeze (OR 1.94, 95% CI: 1.28–2.95) over the same age range. Early-life nonpneumonia LRIs were associated with milder impairment including prebronchodilator FEV1/FVC deficits of –1.1% ± 0.5% and wheeze risk (OR 1.37, 95% CI: 1.09–1.72).
Early childhood pneumonia is associated with asthma and impaired lung function that is partially reversible by bronchodilator. The lung function impairment persists into adulthood and could be a major risk factor for chronic obstructive lung disease.
Previous studies have shown that children with early life pneumonia have deficits in FEV1 and FVC at 35 years (Johnston et al. N Engl J Med. 1998;338:581–587) and at 57.6 years (Shaheen et al. Thorax. 1998;53:549–553), but the FEV1/FVC ratio was not changed. This is the first study that shows a more long-lasting obstructive defect in such children. The authors speculate their findings may be due to the disproportional negative effects of certain viruses (eg, adenovirus and influenza A) on small airways. An alternative and complementary explanation is that children with preexisting small airway caliber may also be at more risk for pneumonia.
- Copyright © 2015 by the American Academy of Pediatrics