Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study

Lystra P Hayden, Brian D Hobbs, Robyn T Cohen, Robert A Wise, William Checkley, James D Crapo, Craig P Hersh, COPDGene Investigators, James Crapo, Edwin Silverman, Barry Make, Elizabeth Regan, Lori Stepp, Sandra Melanson, Sara Penchev, Terri Beaty, Nan Laird, Christoph Lange, Michael Cho, Stephanie Santorico, John Hokanson, Dawn DeMeo, Nadia Hansel, Craig Hersh, Peter Castaldi, Merry-Lynn McDonald, Emily Wan, Megan Hardin, Jacqueline Hetmanski, Margaret Parker, Marilyn Foreman, Brian Hobbs, Robert Busch, Adel El-Bouiez, Peter Castaldi, Megan Hardin, Dandi Qiao, Elizabeth Regan, Eitan Halper-Stromberg, Ferdouse Begum, Sungho Won, Brittney Fredericksen, David A Lynch, Harvey O Coxson, MeiLan K Han, Eric A Hoffman, Stephen Humphries MS, Francine L Jacobson, Philip F Judy, Ella A Kazerooni, John D Newell Jr, Elizabeth Regan, James C Ross, Raul San Jose Estepar, Berend C Stoel, Juerg Tschirren, Eva van Rikxoort, Bram van Ginneken, George Washko, Carla G Wilson, Mustafa Al Qaisi, Teresa Gray, Jessica James, Alex Kluiber, Tanya Mann, Jered Sieren, Douglas Stinson, Robert Jensen, Douglas Everett, Anna Faino, Ruthie Knowles, Joe Piccoli, Matt Strand, Carla Wilson, John E Hokanson, Jennifer Black-Shinn, Gregory Kinney, Sharon Lutz, Katherine Pratte, Jeffrey Curtis, Carlos Martinez, Perry G Pernicano, Nicola Hanania, Philip Alapat, Venkata Bandi, Mustafa Atik, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Amit Parulekar, Arun Nachiappan, Dawn DeMeo, Craig Hersh, George Washko, Francine Jacobson, R Graham Barr, Byron Thomashow, John Austin, Belinda D'Souza, Gregory D N Pearson, Anna Rozenshtein, Neil MacIntyre Jr, Lacey Washington, H Page McAdams, Charlene McEvoy, Joseph Tashjian, Robert Wise, Nadia Hansel, Robert Brown, Karen Horton, Nirupama Putcha, Richard Casaburi, Alessandra Adami, Janos Porszasz, Hans Fischer, Matthew Budoff, Dan Cannon, Harry Rossiter, Michael E DeBakey, Amir Sharafkhaneh, Charile Lan, Christine Wendt, Brian Bell, Marilyn Foreman, Gloria Westney, Eugene Berkowitz, Russell Bowler, David Lynch, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Robert D'Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, Victor Kim, A James Mamary, Nathaniel Marchetti, Aditti Satti, Kartik Shenoy, Robert M Steiner, Alex Swift, Irene Swift, Gloria Vega-Sanchez, Mark Dransfield, William Bailey, J Michael Wells, Surya Bhatt, Hrudaya Nath, Joe Ramsdell, Paul Friedman, Xavier Soler, Andrew Yen, Alejandro Cornellas, John Newell Jr, Brad Thompson, MeiLan Han, Ella Kazerooni, Fernando Martinez, Joanne Billings, Tadashi Allen, Frank Sciurba, Divay Chandra, Joel Weissfeld, Carl Fuhrman, Jessica Bon, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, Mario E Ruiz, Lystra P Hayden, Brian D Hobbs, Robyn T Cohen, Robert A Wise, William Checkley, James D Crapo, Craig P Hersh, COPDGene Investigators, James Crapo, Edwin Silverman, Barry Make, Elizabeth Regan, Lori Stepp, Sandra Melanson, Sara Penchev, Terri Beaty, Nan Laird, Christoph Lange, Michael Cho, Stephanie Santorico, John Hokanson, Dawn DeMeo, Nadia Hansel, Craig Hersh, Peter Castaldi, Merry-Lynn McDonald, Emily Wan, Megan Hardin, Jacqueline Hetmanski, Margaret Parker, Marilyn Foreman, Brian Hobbs, Robert Busch, Adel El-Bouiez, Peter Castaldi, Megan Hardin, Dandi Qiao, Elizabeth Regan, Eitan Halper-Stromberg, Ferdouse Begum, Sungho Won, Brittney Fredericksen, David A Lynch, Harvey O Coxson, MeiLan K Han, Eric A Hoffman, Stephen Humphries MS, Francine L Jacobson, Philip F Judy, Ella A Kazerooni, John D Newell Jr, Elizabeth Regan, James C Ross, Raul San Jose Estepar, Berend C Stoel, Juerg Tschirren, Eva van Rikxoort, Bram van Ginneken, George Washko, Carla G Wilson, Mustafa Al Qaisi, Teresa Gray, Jessica James, Alex Kluiber, Tanya Mann, Jered Sieren, Douglas Stinson, Robert Jensen, Douglas Everett, Anna Faino, Ruthie Knowles, Joe Piccoli, Matt Strand, Carla Wilson, John E Hokanson, Jennifer Black-Shinn, Gregory Kinney, Sharon Lutz, Katherine Pratte, Jeffrey Curtis, Carlos Martinez, Perry G Pernicano, Nicola Hanania, Philip Alapat, Venkata Bandi, Mustafa Atik, Aladin Boriek, Kalpatha Guntupalli, Elizabeth Guy, Amit Parulekar, Arun Nachiappan, Dawn DeMeo, Craig Hersh, George Washko, Francine Jacobson, R Graham Barr, Byron Thomashow, John Austin, Belinda D'Souza, Gregory D N Pearson, Anna Rozenshtein, Neil MacIntyre Jr, Lacey Washington, H Page McAdams, Charlene McEvoy, Joseph Tashjian, Robert Wise, Nadia Hansel, Robert Brown, Karen Horton, Nirupama Putcha, Richard Casaburi, Alessandra Adami, Janos Porszasz, Hans Fischer, Matthew Budoff, Dan Cannon, Harry Rossiter, Michael E DeBakey, Amir Sharafkhaneh, Charile Lan, Christine Wendt, Brian Bell, Marilyn Foreman, Gloria Westney, Eugene Berkowitz, Russell Bowler, David Lynch, Richard Rosiello, David Pace, Gerard Criner, David Ciccolella, Francis Cordova, Chandra Dass, Robert D'Alonzo, Parag Desai, Michael Jacobs, Steven Kelsen, Victor Kim, A James Mamary, Nathaniel Marchetti, Aditti Satti, Kartik Shenoy, Robert M Steiner, Alex Swift, Irene Swift, Gloria Vega-Sanchez, Mark Dransfield, William Bailey, J Michael Wells, Surya Bhatt, Hrudaya Nath, Joe Ramsdell, Paul Friedman, Xavier Soler, Andrew Yen, Alejandro Cornellas, John Newell Jr, Brad Thompson, MeiLan Han, Ella Kazerooni, Fernando Martinez, Joanne Billings, Tadashi Allen, Frank Sciurba, Divay Chandra, Joel Weissfeld, Carl Fuhrman, Jessica Bon, Antonio Anzueto, Sandra Adams, Diego Maselli-Caceres, Mario E Ruiz

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.

Clinical trials registration: ClinicalTrials.gov, NCT00608764 (Active since January 28, 2008).

Figures

Fig. 1
Fig. 1
Lung Function. Decreased lung function with history of childhood pneumonia. Post-bronchodilator spirometry values are shown. Abbreviations: FEV1 = forced expiratory volume in the first second; FVC = forced vital capacity
Fig. 2
Fig. 2
Chest CT. Airway changes on chest CT scans are associated with childhood pneumonia

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