Pubertal onset with adulthood lung function mediated by height growth in adolescence

BACKGROUND: Age of pubertal onset is associated with height and lung function in adulthood. It is unknown whether height growth in adolescence mediates the association of age at puberty with early adult lung function. METHODS: Data from the Isle of Wight (IOW) birth cohort (n=1261) were examined in the study. Ages of pubertal events, height at ages 10 and 18 years and lung function parameters (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV)) at 26 years were included in a path analysis to assess the mediation effects of height growth. Findings were tested in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. RESULTS: In females in the IOW cohort, age at menarche and body hair growth showed a positive indirect association with FVC (menarche: indirect effect coefficient (IEC)=0.13, 95% CI 0.05-0.20, p=1.28×10; body hair growth: IEC=0.08, 95% CI 0.01-0.15, p=0.017) and FEV (menarche: IEC=0.09, 95% CI 0.01-0.17, p=0.028; body hair growth: IEC=0.07, 95% CI 0.01-0.14, p=0.043) at 26 years through height growth and lung function at 18 years. In males, age at body hair growth (IEC=0.08; 95% CI 0.01-0.15, p=0.047), growth spurt (IEC=0.09; 95% CI 0.01-0.17, p=0.034) and facial hair growth (IEC=0.09; 95% CI 0.02-0.16, p=0.014) had positive indirect effects on FVC at 26 years, but voice deepening did not show statistically significant indirect effects (p\u3e0.05). For pubertal events available in the ALSPAC cohort, results consistent with the IOW cohort were found for both females and males. CONCLUSION: Effects of age of puberty on FVC in early adulthood are likely mediated by height growth during adolescence

Cause-specific hospital admission and mortality among working men: association with socioeconomic circumstances in childhood and adult life, and the mediating role of daily stress

BACKGROUND: The aim of this study was to investigate the association of childhood and adulthood social class with the occurrence of specific diseases, including those not associated with a high mortality rate, and to investigate daily stress as the mechanism for that part of any association which cannot be accounted for by established risk factors. METHODS: This was a prospective cohort study with 25 years of follow-up for cause-specific morbidity and mortality. A total of 5577 Scottish men were recruited from 27 workplaces in the West of Scotland. Childhood social class was determined from the occupation held by the individual's father, and adulthood social class from the individual's occupation at enrolment. Daily stress was measured at enrolment using the Reeder Stress Inventory. RESULTS: Health differentials were found for cardiovascular diseases, lung cancer, peptic ulcer, asthma, accidents and violence, alcohol-related diseases, and perhaps psychiatric illness. Adulthood circumstances were associated with the incidence of most diseases in adulthood, the exception being stroke, which was strongly associated with less privileged circumstances in childhood. Both childhood and adulthood circumstances contributed to the incidence of coronary heart disease. Daily stress did not underlie any of these associations once the influence of established risk factors had been taken into account. CONCLUSIONS: Socioeconomic circumstances in childhood and adulthood both contribute to health differentials in adulthood, the relative contributions depending upon the particular disease. Where known risk factors explained only part of the excess of a disease among individuals raised or living in less-privileged circumstances, there was no evidence to suggest that daily stress was the reason for the unexplained excess

Determinants of lung health across the life course in sub-Saharan Africa

Lung health across the life course is influenced by factors affecting airway and alveolar development and growth during antenatal and perinatal periods, throughout childhood and adolescence, and into adulthood. Lung function trajectories are set in early life and childhood deficits may predispose to non-communicable respiratory diseases, such as asthma and chronic obstructive pulmonary disease, in later years. Potential risk factors are common in many sub-Saharan African (sSA) countries; adverse antenatal environments cause in utero growth restriction and prematurity; HIV and respiratory infections, including TB are common; exposure to air pollution is widespread, including household air pollution from biomass fuel use, traffic-related pollution in rapidly expanding cities, and tobacco smoke exposure. Multiple disadvantages experienced in early life require an integrated approach that addresses reproductive, maternal and child health. Public health strategies need to tackle multiple risk factors, emphasising Universal Health Coverage, to maximise lung health in the world’s poorest, most vulnerable populations. This review explores potential determinants of lung health across the life course. Due to the extensive topic and wide range of related literature, we prioritised more recent citations, especially those from sSA, focusing on risk factors for which there is most information, and which are most prevalent in the region

PUBERTY AND DNA METHYLATION WITH LUNG FUNCTION IN YOUNG ADULTS AND ASTHMA ACQUISITION DURING ADOLESCENCE AND YOUNG ADULTHOOD

PUBERTY AND DNA METHYLATION WITH LUNG FUNCTION IN YOUNG ADULTS AND ASTHMA ACQUISITION DURING ADOLESCENCE AND YOUNG ADULTHOO

Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk

Rationale Lung function in early adulthood is associated with subsequent adverse health outcomes.Objectives To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function.Methods Using latent profile modelling, we studied three population-based birth cohorts with repeat spirometry data from childhood into early adulthood to identify trajectories of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). We used multinomial logistic regression models to investigate early-life predictors of the derived trajectories. We then ascertained the extent of the association between the derived FEV1/FVC trajectories and blood pressure and echocardiographic markers of increased cardiovascular risk and stroke in ~3200 participants at age 24 years in one of our cohorts.ResultsWe identified four FEV1/FVC trajectories with strikingly similar latent profiles across cohorts (pooled N=6377): above average (49.5%); average (38.3%); below average (10.6%); and persistently low (1.7%). Male sex, wheeze, asthma diagnosis/medication and allergic sensitisation were associated with trajectories with diminished lung function in all cohorts. We found evidence of an increase in cardiovascular risk markers ascertained by echocardiography (including left ventricular mass indexed to height and carotid intima-media thickness) with decreasing FEV1 /FVC (with p values for the mean crude effects pertrajectory ranging from 0.10 to p<0.001). In this analysis, we considered trajectories as a pseudo-continuous variable; we confirmed the assumption of linearity in all the regression models.ConclusionsChildhood lung function trajectories may serve as predictors in the development of not only future lung disease, but also the cardiovascular disease and multimorbidity in adulthood

Predicting the course of asthma from childhood until early adulthood

PURPOSE OF REVIEW: To communicate recent insights about the natural history of childhood asthma, with a focus on prediction of persistence and remission of childhood asthma, up to early adulthood.RECENT FINDINGS: Lung function around the age of 8-9 years is the strongest predictor: obstructive lung function predicts asthma persistence up to early adulthood, whereas normal lung function predicts remission. The ability to predict asthma remission improves when lung function is combined with blood eosinophil levels and degree of bronchial hyperresponsiveness. Interventions, such as inhaled corticosteroids and immunotherapy do not appear to alter the course of asthma. Epigenetic studies have revealed potential novel biomarkers of asthma remission, such as micro-RNA patterns in blood. Specifically, lower serum levels of mi-R221-5p, which is associated with lower IL-6 release and eosinophilic inflammation, predict remission. Higher levels of blood DNA-methylation of a CpG site in Peroxisomal Biogenesis Factor 11 Beta were associated with asthma remission.SUMMARY: Lung function, allergic comorbidity and polysensitization in childhood predict the course of asthma. Recent epigenetic studies have provided a better understanding of underlying pathological processes in asthma remission, which may be used to improve prediction or develop novel treatments aimed at altering the course of asthma.</p

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

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/M015181/1Peer reviewedPostprin

Lung function from school age to adulthood in primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) presents with symptoms early in life and the disease course may be progressive, but longitudinal data on lung function are scarce. This multinational cohort study describes lung function trajectories in children, adolescents and young adults with PCD. We analysed data from 486 patients with repeated lung function measurements obtained between the age of 6 and 24 years from the International PCD Cohort and calculated z-scores for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio using the Global Lung Function Initiative 2012 references. We described baseline lung function and change of lung function over time and described their associations with possible determinants in mixed-effects linear regression models. Overall, FEV1, FVC and FEV1/FVC z-scores declined over time (average crude annual FEV1 decline was -0.07 z-scores), but not at the same rate for all patients. FEV1 z-scores improved over time in 21% of patients, remained stable in 40% and declined in 39%. Low body mass index was associated with poor baseline lung function and with further decline. Results differed by country and ultrastructural defect, but we found no evidence of differences by sex, calendar year of diagnosis, age at diagnosis, diagnostic certainty or laterality defect. Our study shows that on average lung function in PCD declines throughout the entire period of lung growth, from childhood to young adult age, even among patients treated in specialised centres. It is essential to develop strategies to reverse this tendency and improve prognosi

Asthma in adolescents, during the transition from child to adult, effects on physiological parameters and health related quality of life

The aims of this thesis were to evaluate physiological and allergic aspects and consequences of asthma and possible correlation between Health Related Quality of Life (HRQOL) and atopy, lung function, bronchial hyper-responsiveness and regular physical exercise. Possible risk factors for deterioration among patients in their late teenage years prior to and following transfer to adult healthcare were examined. The study was designed to investigate possible differences between boys and girls, changes over time in these respects and additionally the impact of randomized referral to either a specialized asthma clinic or primary care on the same factors. In this prospective study, conducted at the asthma/allergy clinic of the Childrens Hospital at Huddinge University 155 teenagers (69 females) with asthma were followed over a five year period. The patients were recruited consecutively and were screened employing spirometry, histamine challenge (to investigate bronchial hyper-responsiveness), skin prick test for allergy, and filled out The Living With Asthma Questionnaire both at the time of entry into the study and after 2 and 5 years of follow-up. An exercise test and questions about regular performed exercise were carried out at baseline and 5 years later. Adolescents with mild-to-moderate asthma were assigned randomly to care at the adult asthma clinic or primary care. When entering the study 89% were atopic. Lung-function increased from 94.0% of predicted (FEV1 mean value for the whole group (SD 12.9%) to 97.7% over the study period. Their Bronchial hyper-responsiveness decreased (PD20 for histamine chloride was median 440µg at entrance and increased five years later to 790µg) and working capacity decreased. At all three time points HRQOL for the men was generally better than that of the women. After five years HRQOL increased for both men and women but still the men had better HRQOL at the total score (of the scale) compared to the women. Young women who exercised regularly exhibited significant better HRQOL than those who did not whereas regular exercise had no impact on the HRQOL of the young men. Women with severe asthma demonstrated a poorer HRQOL than those suffering from mild-to-moderate asthma. Lung function, atopy, bronchial hyperresponsiveness did not exert any impact on HRQOL. Poor adherence to asthma treatment was associated with lower HRQOL as well as bronchial hyper-responsiveness. Adolescents with mild-to-moderate asthma showed no difference in HRQOL regardless of whether they received specialized treatment or primary care, lung function, atopy or bronchial hyper-responsiveness. Suffering from asthma during late adolescence was associated with lower HRQOL for women than for men and this negative impact on adolescent women was enhanced when asthmatic symptoms were more severe. The HRQOL of both male and females improved as they grew older and entered adulthood. Lung function improved but hyper-responsiveness persisted. Female gender and poor adherence to asthma treatment exerted negative impact on bronchialhyper responsiveness and HRQOL which emphasizes the importance of health care programs that include patient education and support for adolescents with asthma as they are transferred from pediatric to adult health care. Mild-to-moderate asthma care can be equally handled in the primary care system

Asthma Exacerbations are Associated with a decline in Lung Function : A Longitudinal Population-Based Study

Funding This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution. Acknowledgements The authors thank the UK primary care sites that contributed anonymised patient data to this study; Drs Jaco Voorham and Marjan Kerkhof for their contributions to the preparation and analysis of the data; and Audrey Ang and Andrea Teh Xin Yi for coordinating logistical and administrative support for the development of this manuscript. We also thank our Thorax peer reviewers for their in-depth comments and suggestions which greatly improved the quality of this article.Peer reviewedPostprin