Persistent Childhood Asthma Linked to Early COPD

Published 17 May 2016

Persistent childhood asthma may be linked to earlier development of chronic obstructive pulmonary disease (COPD), according to results from the Childhood Asthma Management Program (CAMP) study published in the May 12 issue of the New England Journal of Medicine.

Although COPD rarely develops before the fourth decade of life and typically affects current or former smokers, 11% of the children in this study met Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD by age 30 years. Children with a decreased pattern of lung growth or decreased lung function at study entry and males were at increased risk.

"Our data support the hypothesis that both reduced growth and an early decline are trajectories leading to an asthma–COPD overlap syndrome and complement the recent observation that in older patients, a rapid decline in lung function can lead to COPD," write Michael J McGeachie, PhD, from Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, and colleagues.

Past studies have linked early decline in lung function and a pattern of decreased lung growth to the development of COPD. A recent study found that poorer lung function in early adulthood is associated with the development of COPD later in life. However, long-term data on the issue are limited in children with asthma, who are already at increased risk for airflow obstruction.

The current analysis was part of the randomized placebo-controlled CAMP study, which enrolled children aged 5 to 12 years with mild to moderate asthma and followed them into the third decade of life. The larger CAMP study found that inhaled anti-inflammatory agents were no better than placebo in terms of their long-term effects on lung function growth. During the study, participants underwent annual spirometry lung function assessments.

Researchers identified 684 CAMP participants who had mild to moderate persistent asthma despite medication use. They separated these children into four groups, based on their trajectories of lung growth and decline in lung function, as measured by forced expiratory volume in 1 second (FEV1). FEV1 is a measure of lung function that usually peaks in late adolescence or early adulthood, but then remains stable for many years before starting a gradual decline. The four categories included normal growth with normal peak, normal growth and early decline, reduced growth and normal peak, and reduced growth and early decline.

Results showed that 75% (n=514) of children showed abnormal patterns of lung growth before their early twenties: 26% (n=176) showed reduced lung growth along with early decline, 23% (n=160) had reduced lung growth alone, and 26% (n=178) had normal lung growth and early decline.

Decreased lung function at baseline and male sex were the strongest predictors of impaired lung function later in life. Reasons why males might be at increased are unknown, although they were a little more than eight times more likely to have a reduced pattern of lung growth compared with those with normal growth (odds ratio, 8.18; P < .001).

Other factors associated with decreased lung growth included less bronchodilator response, airway hyperresponsiveness, young age at study entry, maternal smoking during gestation, lower level of parental education, vitamin D insufficiency, number of courses of prednisone, and more positive skin tests.

By about age 26 years, 11% (n = 73) of participants had lung impairment suggestive of COPD, as defined by the GOLD criteria. Thirty-six percent of participants with a reduced lung growth pattern and 8% of those with a normal growth pattern met GOLD criteria for COPD (P < .001).

The study could not conclusively assess smoking exposure, a known risk factor for COPD. It also could not look at genetic risk factors, prematurity, childhood respiratory infections, and other environmental exposures.

The length of follow-up was also too short to assess the full extent to which early decline in lung function in patients with asthma contributes to COPD, Stefano Guerra, MD, PhD, associate professor of medicine at the University of Arizona in Tucson, told Medscape Medical News.

Nevertheless, he commented: "These findings have critical implications in terms of tertiary prevention because they indicate that interventions aimed at reducing the long-term sequelae of childhood asthma need to start early in life and to target patients years before they enter adulthood."

The authors note that more studies are needed to identify interventions that could improve outcomes in children with mild to moderate persistent asthma.

One or more authors reports receiving grants, fees, or other support from one or more of the following: National Institutes of Health, Alpha-1 Foundation, National Heart Lung Blood Institute, Roche, Merck, GlaxoSmithKline, AstraZeneca, Brigham and Women's Hospital, Agency for Healthcare Research and Quality, ICON Medical Imaging, Novartis, Dutch Lung Foundation, Teva, Ubbo Emmius Foundation, Stichting Astma Bestrijding, Parker B. Francis Foundation, Boehringer Ingelheim, Takeda, Chiesi, UpToDate, Genentech, Aerocrine, Mylan, Sunovion, Pfizer, Pulmonx, Spiration, Vertex, Verona, Bristol-Myers Squibb, Janssen, Theravance, and MedImmune. Dr Guerra has disclosed no relevant financial relationships.

1 comment

Unregistered member

on 03/06/2016

Hi, I'm 49 and I was diagnosed with Asthma aged 12, this was based of presentation of wheeze and breathlessness as well as my paternal uncle having brittle Asthma. when I was aged 29 I was diagnosed with COPD. It wasn't until I reached the age of 39 that it was discovered that my initial diagnosis of Asthma aged 12 was infact wrong. I actually had an undiagnosed condition called Scheuermanns Disease of my spine. As a young toddler aged 18 months I was admitted to Great Ormond Street childrens Hospital with failure to thrive, malabsorption. I also had very short stature and even at the age of 3, I was still in clothing aged 18mths. It was always stated that I would be 18mths behind in growth for my actual age. Looking back at photos of myself I can now see how tiny I was.

My Rheumatolgy Consultant stated that if my wheeze and breathlessness had been further investigated when I was aged 12 the diagnosis of Scheuermanns would have been noted and I would of been placed in a spinal brace or plastercast following the insertion of Harrington rods fixed to either side of my spine to help straighten my back. The condition of Scheuermanns disease caused my spine to curve and this caused my diagphram to become squashed, which caused the wheeze and breathlessness. Now looking at photographs of my paternal uncle and from childhood memory my uncle had quite a significant hump on his back, this was always perceived to have been from him spending a lot of time hunched over due to coughing. Unfortunately back then the medical equipment which we have today wasn't even in operation back then.

My parents were both smokers and my paternal grandfather also smoked a pipe, we used to spend every Saturday with him and my nan and I remember him always puffing on his pipe. My maternal grandfather also smoked cigarettes so I was exposed to the second hand smoke from a very young age. The effects of second hand smoke was not noted back then. I started smoking in my teenage years as like many thought it was cool, now I know different. I am now a non smoker and I'm in my 3rd year, I had tried many times before but fell off the wagon.

In 2012 aged 45 I was diagnosed with Avascular Necrosis of my jaw joints and required surgery to replace both my jaw joints with Titanium implants. The Titanium jaw joints were a cost of $16,000 a side and were made by a company called TMJ Concepts in Verona California USA, I had to travel 180 miles from my home in the UK to Birmingham UK for the surgery. It was this that gave me the push to attempt to give up smoking, as I felt if they were prepared to invest such a huge amount of money I owed it to them to do my best in quitting smoking. Which I managed, and in March 2015 I underwent the 6 hour surgery to replace my jaw joints with Titanium implants. A specialised Anaesthetis in respiratory compromised persons looked after me during the surgery. I knew there were huge risks with this length of time under anaesthetic and ensured all my affairs were in order.

Im now 15 months on from the surgery, all went well and my progress is good. I do battle quite a number of complex health problems and I do find each day a struggle.

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