Low Peak Lung Function May Identify Individuals at Risk for Early Comorbidities

Low peak lung function (defined as forced expiratory volume in 1 second [FEV₁] <80% predicted) in early adulthood is associated with an increased prevalence and earlier incidence of respiratory, cardiovascular, and metabolic comorbidities, as well as premature death, according to the results of a recent transgenerational Spanish cohort analysis published in the Lancet Respiratory Medicine.

The investigators tested their hypothesis using data from the Framingham Offspring Cohort (FOC) and validated their observations in the Coronary Artery Risk Development in Young Adults (CARDIA) study cohort and the Framingham Generation III (GenIII) cohort, the latter of whom were direct descendants of FOC participants. These 3 general population cohorts included men and women who were regularly and prospectively followed to collect extensive clinical, physiologic, biologic, and imaging data. Main study outcomes were prevalence (in early adulthood) and incidence (during follow-up) of comorbidities and all-cause mortality.

Overall, 10% (111/1161) of participants from FOC, 13% (338/2648) of participants from CARDIA, and 4% (71/1912) of participants from GenIII had FEV₁ <80% predicted at 25 to 40 years of age. These same individuals also had a higher prevalence of respiratory, cardiovascular, and metabolic abnormalities in early adulthood, as well as a significantly higher and earlier (by about a decade) incidence of comorbidities during follow-up (39 vs 47 years, respectively, in FOC; 30 vs 37 years, respectively, in CARDIA; P <.0001).

Moreover, in early adulthood, participants from FOC had significantly higher all-cause mortality compared with individuals with normal lung function (hazard ratio [HR], 2.3; 95% CI, 1.4-3.7; P =.001).

In GenIII, participants with at least 1 parent who had low lung function in early adulthood in FOC (n=115) had lower FEV₁ in early adulthood (10% had FEV₁ <80% predicted; in those with both parents classified as normal in FOC [n=248], 3% had FEV₁ <80% predicted [P <.0001]). In addition, early adulthood FEV₁ in GenIII participants was significantly related to the average FEV₁ of FOC parents in early adulthood (P <.0001).

The investigators concluded that low peak lung function in early adulthood may identify individuals at risk for poor health outcomes later in life. The use of spirometry during infancy or early adulthood might help identify individuals at risk for poor health outcomes and facilitate the implementation of effective preventive or therapeutic measures, and warrants further research.

Reference

Agustí A, Noell G, Brugada J, Faner R. Lung function in early adulthood and health in later life: a transgenerational cohort analysis. Lancet Respir Med. 2017;5(12):935-945.