Section of Thoracic Medicine, Institute of Medicine, University of Bergen, Norway.
Thorax. 2010 Jan;65(1):14-20. doi: 10.1136/thx.2008.112136. Epub 2009 Sep 2.
Early life development may influence subsequent respiratory morbidity. The impact of factors determined in childhood on adult lung function, decline in lung function and chronic obstructive pulmonary disease (COPD) was investigated.
European Community Respiratory Health Survey participants aged 20-45 years randomly selected from general populations in 29 centres underwent spirometry in 1991-3 (n = 13 359) and 9 years later (n = 7738). Associations of early life factors with adult forced expiratory volume in 1 s (FEV(1)), FEV(1) decline and COPD (FEV(1)/FVC ratio <70% and FEV(1) <80% predicted) were analysed with generalised estimating equation models and random effects linear models.
Maternal asthma, paternal asthma, childhood asthma, maternal smoking and childhood respiratory infections were significantly associated with lower FEV(1) and defined as "childhood disadvantage factors"; 40% had one or more childhood disadvantage factors which were associated with lower FEV(1) (men: adjusted difference 95 ml (95% CI 67 to 124); women: adjusted difference 60 ml (95% CI 40 to 80)). FEV(1) decreased with increasing number of childhood disadvantage factors (> or =3 factors, men: 274 ml (95% CI 154 to 395), women: 208 ml (95% CI 124 to 292)). Childhood disadvantage was associated with a larger FEV(1) decline (1 factor: 2.0 ml (95% CI 0.4 to 3.6) per year; 2 factors: 3.8 ml (95% CI 1.0 to 6.6); > or =3 factors: 2.2 ml (95% CI -4.8 to 9.2)). COPD increased with increasing childhood disadvantage (1 factor, men: OR 1.7 (95% CI 1.1 to 2.6), women: OR 1.6 (95% CI 1.01 to 2.6); > or =3 factors, men: OR 6.3 (95% CI 2.4 to 17), women: OR 7.2 (95% CI 2.8 to 19)). These findings were consistent between centres and when subjects with asthma were excluded.
People with early life disadvantage have permanently lower lung function, no catch-up with age but a slightly larger decline in lung function and a substantially increased COPD risk. The impact of childhood disadvantage was as large as that of heavy smoking. Increased focus on the early life environment may contribute to the prevention of COPD.
早期生活的发展可能会影响随后的呼吸道发病率。本研究旨在探讨儿童时期确定的因素对成人肺功能、肺功能下降和慢性阻塞性肺疾病（COPD）的影响。
欧洲社区呼吸健康调查在 29 个中心随机选择了年龄在 20-45 岁的普通人群中的参与者，他们在 1991-3 年（n=13359）和 9 年后（n=7738）接受了肺功能检查。采用广义估计方程模型和随机效应线性模型分析了早期生活因素与成人 1 秒用力呼气量（FEV1）、FEV1 下降和 COPD（FEV1/FVC 比值<70%和 FEV1<80%预测值）的相关性。
母亲哮喘、父亲哮喘、儿童哮喘、母亲吸烟和儿童呼吸道感染与较低的 FEV1 显著相关，被定义为“儿童期不利因素”；40%的人有一个或多个儿童期不利因素，与较低的 FEV1 相关（男性：调整差异 95ml（95%CI 67 至 124）；女性：调整差异 60ml（95%CI 40 至 80））。随着儿童期不利因素数量的增加（≥3 个因素，男性：274ml（95%CI 154 至 395），女性：208ml（95%CI 124 至 292）），FEV1 下降。儿童期不利因素与较大的 FEV1 下降相关（1 个因素：每年 2.0ml（95%CI 0.4 至 3.6）；2 个因素：3.8ml（95%CI 1.0 至 6.6）；≥3 个因素：2.2ml（95%CI -4.8 至 9.2））。随着儿童期不利因素的增加，COPD 的风险也随之增加（1 个因素，男性：OR 1.7（95%CI 1.1 至 2.6），女性：OR 1.6（95%CI 1.01 至 2.6）；≥3 个因素，男性：OR 6.3（95%CI 2.4 至 17），女性：OR 7.2（95%CI 2.8 至 19））。这些发现在中心之间是一致的，并且当排除哮喘患者时也是一致的。
早期生活不利的人肺功能永久较低，与年龄无关，但肺功能下降略大，COPD 风险显著增加。儿童期不利因素的影响与重度吸烟相当。增加对生命早期环境的关注可能有助于预防 COPD。
