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TRAJECTORIES OF LUNG FUNCTION DURING CHILDHOOD
Danielle C. M. Belgrave, Iain Buchan, Christopher Bishop, Lesley Lowe, Angela Simpson, Adnan Custovic
American Journal of Respiratory and Critical Care Medicine. 2014;.
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Abstract
Background: We explored longitudinal trajectories of lung function during childhood and factors associated with lung function decline. Methods: In a population-based birth cohort, specific airway resistance (sRaw) was assessed at age 3 (n=560), 5 (n=829), 8 (n=786) and 11 years (n=644). Based on prospective data (questionnaires, skin tests, IgE), children were assigned to wheeze phenotypes (No wheezing, Transient, Late-onset and Persistent) and atopy phenotypes (No atopy; Dust mite; Non-dust mite; Multiple early; Multiple late). We used longitudinal linear mixed models to determine predictors of change in sRaw over time. Results: Contrary to the assumption that sRaw is independent of age/sex, boys had higher sRaw than girls (mean difference 0.080, 95%CI 0.049-0.111, p<0.001) and a higher rate of increase over time. For girls, sRaw increased by 0.017 kPaâ¢s-1 per year (95%CI 0.011-0.023). In boys this increase was significantly greater (p=0.012; mean between-sex difference 0.011 kPaâ¢s-1, 95%CI 0.003-0.019). Children with persistent wheeze (but not other wheeze phenotypes) had a significantly greater rate of deterioration in sRaw over time compared to never wheezers (p=0.009). Similarly, children with Multiple early, but not other atopy phenotypes had significantly poorer lung function than non-atopics (mean difference 0.116 kPaâ¢s-1, 95%CI 0.065-0.168, p<0.001). sRaw increased progressively with the increasing number of asthma exacerbations. Conclusion: Children with persistent wheeze, frequent asthma exacerbations and multiple early atopy have diminished lung function throughout childhood, and are at risk of a progressive loss of lung function from age three to 11 years. These effects are more marked in boys.
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