Abstract
BackgroundDevelopment of adult respiratory disease is influenced by events in childhood. The impact of childhood pneumonia on chronic obstructive pulmonary disease (COPD) is not well defined. We hypothesize that childhood pneumonia is a risk factor for reduced lung function and COPD in adult smokers.MethodsCOPD cases and control smokers between 45–80 years old from the United States COPDGene Study were included. Childhood pneumonia was defined by self-report of pneumonia at <16 years. Subjects with lung disease other than COPD or asthma were excluded. Smokers with and without childhood pneumonia were compared on measures of respiratory disease, lung function, and quantitative analysis of chest CT scans.ResultsOf 10,192 adult smokers, 854 (8.4 %) reported pneumonia in childhood. Childhood pneumonia was associated with COPD (OR 1.40; 95 % CI 1.17-1.66), chronic bronchitis, increased COPD exacerbations, and lower lung function: post-bronchodilator FEV1 (69.1 vs. 77.1 % predicted), FVC (82.7 vs. 87.4 % predicted), FEV1/FVC ratio (0.63 vs. 0.67; p < 0.001 for all comparisons). Childhood pneumonia was associated with increased airway wall thickness on CT, without significant difference in emphysema. Having both pneumonia and asthma in childhood further increased the risk of developing COPD (OR 1.85; 95 % CI 1.10-3.18).ConclusionsChildren with pneumonia are at increased risk for future smoking-related lung disease including COPD and decreased lung function. This association is supported by airway changes on chest CT scans. Childhood pneumonia may be an important factor in the early origins of COPD, and the combination of pneumonia and asthma in childhood may pose the greatest risk.Clinical trials registrationClinicalTrials.gov, NCT00608764 (Active since January 28, 2008).Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-015-0273-8) contains supplementary material, which is available to authorized users.
Highlights
Development of adult respiratory disease is influenced by events in childhood
This study examines the effect of childhood pneumonia in a large population of older adults, including objective diagnosis of chronic obstructive pulmonary disease (COPD) with standardized post-bronchodilator spirometry and analysis of chest computed tomography (CT)
Subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage 1 spirometry (FEV1/forced vital capacity (FVC) < 0.7 with Forced expiratory volume in the first second (FEV1) ≥ 80 % predicted) or subjects with Preserved Ratio Impaired Spirometry (PRISm, FEV1/FVC ≥ 0.7 with FEV1 < 80 % predicted) were not included in COPD analysis; they were included in the other assessments [27]
Summary
Development of adult respiratory disease is influenced by events in childhood. The impact of childhood pneumonia on chronic obstructive pulmonary disease (COPD) is not well defined. We hypothesize that childhood pneumonia is a risk factor for reduced lung function and COPD in adult smokers. Multiple investigations have found an association between pneumonia in childhood and decreased adult lung function, raising the question of whether childhood pneumonia is a risk factor for chronic obstructive pulmonary disease (COPD). Hayden et al Respiratory Research (2015) 16:115 development, and increased susceptibility to smoking related injury [10, 13,14,15]. More data is needed to guide providers in anticipating the outcomes of childhood pneumonia and potential additional complications from smoking
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