Early COPD Linked to Childhood Asthma

There is evidence of a link between persistent childhood asthma and chronic obstructive pulmonary disease (COPD) in early adulthood, according to findings published in the New England Journal of Medicine.

Researchers from Brigham and Women’s Hospital examined nearly 700 COPD patients in order to track longitudinal measurements of growth and decline in lung function with persistent childhood asthma. The patients were between five and 12 years of age and monitored once per year until they were at least 23 years old. Pediatric patients were classified into four groups based on their lung function growth and decline, measured by testing the forced expiratory volume in one second (FEV 1), which researchers said represented the spirometric measurements performed in childhood into adulthood.

At the end of the study, about a quarter of the patients had normal lung function without any indication of decline, the researchers reported. The remaining 75 percent showed abnormal patterns. About a quarter of the patients showed reduced growth and an early decline, another quarter demonstrated reduced growth only and the remaining quarter showed normal growth and an early decline, according to the findings.

Factors implicating reduced growth included lower baseline FEV 1 values, smaller bronchodilator response, airway hyper responsiveness at baseline and male sex.

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Most significantly, 11 percent of the participants (73 patients) met diagnostic criteria for COPD, which one study author called “astonishing” and “terrible.” The study authors said that these patients were more likely to have a reduced pattern of growth than a normal pattern: 18 percent vs. 3 percent, respectively.

The researchers said that day to day activities such as holding a job will become difficult for these particular patients sooner than most as their COPD evolves.

“This work tells us that persistent childhood asthma can develop into COPD, something that up until now has not been well described,” senior author Scott T. Weiss, MD, explained in a press release. “Children who had low lung function at the start of the trial followed a series of predicted growth patterns: most had reduced lung growth with time and a significant number would go on to meet the criteria for COPD.”

The researchers added in the statement that the causes of the development of persistent childhood asthma are unknown, and about one in five patients will proceed to have potentially severe symptoms in adulthood.

“With this understanding, physicians need to identify at risk children earlier and counsel them about potential preventative measures,” Weiss concluded. “Since asthma itself is a risk factor for developing COPD, these patients should be advised against risk related environmental exposures, like smoking, that could intensify their symptoms and increase their COPD risk. It is important that we recognize this link between persistent childhood asthma and COPD as a potential problem and focus on prevention efforts.