title: Early life origins of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Thoracic Medicine, Institute of Medicine, University of Bergen, Norway. cecilie.svanes@med.uib.no
authors.forename: C
authors.initials: C
authors.lastname: Svanes
authors.forename: J
authors.initials: J
authors.lastname: Sunyer
authors.forename: E
authors.initials: E
authors.lastname: Plana
authors.forename: S
authors.initials: S
authors.lastname: Dharmage
authors.forename: J
authors.initials: J
authors.lastname: Heinrich
authors.forename: D
authors.initials: D
authors.lastname: Jarvis
authors.forename: R
authors.initials: R
authors.lastname: de Marco
authors.forename: D
authors.initials: D
authors.lastname: Norbäck
authors.forename: C
authors.initials: C
authors.lastname: Raherison
authors.forename: S
authors.initials: S
authors.lastname: Villani
authors.forename: M
authors.initials: M
authors.lastname: Wjst
authors.forename: K
authors.initials: K
authors.lastname: Svanes
authors.forename: J M
authors.initials: JM
authors.lastname: Antó
mesh_terms: D000328:Adult; D017668:Age of Onset; D001249:Asthma / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D004812:Epidemiologic Methods; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012907:Smoking / Q000009:adverse effects; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult