title: Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  COPD 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.
  
  
  RESULTS
  Of 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).
  
  
  CONCLUSIONS
  Children 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.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT00608764 (Active since January 28, 2008).
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. Lystra.Hayden@childrens.harvard.edu.|Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Ave., Boston, MA, 02115, USA. Lystra.Hayden@childrens.harvard.edu.
authors.forename: Lystra P
authors.initials: LP
authors.lastname: Hayden
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Ave., Boston, MA, 02115, USA. brian.hobbs@channing.harvard.edu.|Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. brian.hobbs@channing.harvard.edu.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Hobbs
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, 72 E Concord St., Boston, MA, 02118, USA. Robyn.Cohen@bmc.org.
authors.forename: Robyn T
authors.initials: RT
authors.lastname: Cohen
authors.affiliation: Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD, 21205, USA. rwise@jhmi.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.affiliation: Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD, 21205, USA. wcheckl1@jhmi.edu.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.affiliation: Department of Medicine, National Jewish Health, 1400 Jackson St., Denver, CO, 80206, USA. CrapoJ@njhealth.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Crapo
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Ave., Boston, MA, 02115, USA. craig.hersh@channing.harvard.edu.|Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. craig.hersh@channing.harvard.edu.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Hersh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001991:Bronchitis / Q000453:epidemiology / Q000209:etiology; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000235:genetics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000235:genetics*; D011656:Pulmonary Emphysema / Q000453:epidemiology / Q000473:pathology; D012129:Respiratory Function Tests; D012137:Respiratory System / Q000473:pathology; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D014797:Vital Capacity