Investigators from the University of Arizona and Hong Kong determined whether pneumonia and other lower respiratory infections (LRIs) that occurred during the first 3 years of life were associated with impaired lung function in adulthood. For the study, data were collected on adults who had been enrolled in the Tucson Children’s Respiratory Study. In a previous analysis of this cohort, investigators had shown that early pneumonia was associated with persistent airway obstruction up to age 11.1 In the present study, investigators analyzed data from this same cohort through age 29.
The primary exposure variable was LRI diagnosed in an outpatient setting during the first 3 years of life. Parents in the cohort were instructed to see their child’s pediatrician if the child participant developed deep or “wet” chest cough, wheezing, hoarseness, stridor, barking cough, or shortness of breath. Pediatricians subsequently recorded the child participant’s history and physical findings on a study form. For participants diagnosed with LRI, the LRI was classified as either pneumonia (defined as pediatrician-diagnosed with radiologic evidence), or other. The primary outcome variables included (1) lung function, as measured by pre- and post-bronchodilator spirometry indices (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], and forced expiratory flow between 25% and 75% of the FVC [FEF25–75]), and (2) physician-diagnosed asthma during the previous year, as measured by parent or participant report. Spirometry was performed at ages 11, 16, 22, and 26 years, and occurrence of asthma was elicited at ages 11, 13, 16, 18, 22, 24, 26, and 29 years. The association between exposure and outcome variables was adjusted for demographics, participant smoking status, participant atopy, parental smoking, and other potential confounders.
Of the original 1,246 children in the study, data were analyzed on 646 adult participants. Of these, 44 had pneumonia in the first 3 years of life, 294 had other LRIs, and 308 had no LRI. Participants who had pneumonia or other LRIs had at least 1 significantly lower pre-bronchodilator FEV1, FEV1:FVC ratio, FEF25–75, and FEF25–75:FVC ratio, measured from age 11 to 26 years in adjusted models, compared to those with no LRI. Early childhood pneumonia was also significantly associated with worse post-bronchodilator pulmonary function test results. Participants with pneumonia had more impaired spirometry indices than those with other LRIs. Participants who had pneumonia also had a significantly higher risk of physician-diagnosed asthma up to age 29 years in adjusted models compared to participants with no LRIs (OR = 1.95; 95% CI, 1.11–3.44). Participants with other LRIs did not have a significantly higher risk of asthma.
The authors conclude that early childhood pneumonia is associated with asthma and impaired lung function in adulthood that is only partially reversible...