Pneumonia in childhood and impaired lung function in adults: a longitudinal study.
BACKGROUND
Diminished lung function and increased prevalence of asthma have been reported in children with a history of early lower respiratory illnesses (LRIs), including pneumonia. Whether these associations persist up to adulthood has not been established.


METHODS
As part of the prospective Tucson Children's Respiratory Study, LRIs during the first 3 years of life were ascertained by pediatricians. Spirometry was performed at ages 11, 16, 22, and 26 years. The occurrence of asthma/wheeze during the previous year was ascertained at ages 11, 13, 16, 18, 22, 24, 26, and 29 years. Longitudinal random effects models and generalized estimating equations were used to assess the relation of LRIs to lung function and asthma.


RESULTS
Compared with participants without early-life LRIs, those with pneumonia had the most severe subsequent lung function impairment, with mean ± SE deficits of -3.9% ± 0.9% (P < .001) and -2.5% ± 0.8% (P = .001) for pre- and post-bronchodilator FEV1:FVC ratio from age 11 to 26 years, respectively. Pneumonia was associated with increased risk for asthma (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.11-3.44) and wheeze (OR: 1.94; 95% CI: 1.28-2.95) over the same age range. Early non-pneumonia LRIs were associated with mildly impaired pre-bronchodilator FEV1 (-62.8 ± 27.9 mL, P = .024) and FEV1:FVC ratio (-1.1 ± 0.5%, P = .018), and wheeze (OR: 1.37; 95% CI: 1.09-1.72).


CONCLUSIONS
Early pneumonia is associated with asthma and impaired airway function, which is partially reversible with bronchodilators and persists into adulthood. Early pneumonia may be a major risk factor for adult chronic obstructive pulmonary disease.
Department of Pediatrics, Kwong Wah Hospital, Hospital Authority, Kowloon, Hong Kong; and Arizona Respiratory Center, University of Arizona, Tucson, Arizona.
Johnny Y C
JY
Chan
Arizona Respiratory Center, University of Arizona, Tucson, Arizona.
Debra A
DA
Stern
Arizona Respiratory Center, University of Arizona, Tucson, Arizona.
Stefano
S
Guerra
Arizona Respiratory Center, University of Arizona, Tucson, Arizona.
Anne L
AL
Wright
Arizona Respiratory Center, University of Arizona, Tucson, Arizona.
Wayne J
WJ
Morgan
Arizona Respiratory Center, University of Arizona, Tucson, Arizona fdmartin@email.arizona.edu.
Fernando D
FD
Martinez
D000293:Adolescent; D000328:Adult; D001130:Arizona; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D011014:Pneumonia / Q000175:diagnosis* / Q000453:epidemiology*; D012135:Respiratory Sounds / Q000209:etiology*; D012307:Risk Factors; D013147:Spirometry; D014797:Vital Capacity; D055815:Young Adult
asthma; early childhood pneumonia; lung function