RT Journal
A1 Mullane D, Turner SW, Cox DW, Goldblatt J, Landau LI, le Souëf PN
T1 REduced infant lung function, active smoking, and wheeze in 18-year-old individuals
JF JAMA Pediatrics
JO JAMA Pediatrics
YR 2013
FD April 1
VO 167
IS 4
SP 368
OP 373
DO 10.1001/jamapediatrics.2013.633
UL http://dx.doi.org/10.1001/jamapediatrics.2013.633
AB Importance 
                  This is the first study to link reduced lung function in early life, before the development of symptoms, to wheeze in 18-year-olds. Additionally, the study gives insight into factors other than reduced lung function that are also associated with persistent wheeze in young adults.Objective 
                  To test the hypothesis that reduced lung function in early life is associated with increased risk for persistent wheeze at age 18 years.Design 
                  Birth cohort study.Setting 
                  Perth, Western Australia.Participants 
                  Individuals followed up from age 1 month to 18 years.Main Outcome Measures 
                  Maximal flow at functional residual capacity (V′maxFRC) was measured in 1-month-old infants who were followed up at ages 6, 12, and 18 years. Based on reported symptoms, individuals were categorized as having remittent wheeze, later-onset wheeze, persistent wheeze, and no wheeze. Smoking status was noted at age 18 years.Results 
                  Of the 253 individuals originally recruited, 150 were followed up at age 18 years; 37 of the 150 had recent wheeze. Compared with the no-wheeze group (n = 96), persistent wheeze (n = 13) was independently associated with reduced percentage of predicted V′maxFRC (mean reduction, 43%; 95% CI, 13-74). Compared with the no-wheeze group, persistent wheeze was also associated with atopy in infancy (odds ratio = 7.1; 95% CI, 1.5-34.5), maternal asthma (odds ratio = 6.8; 95% CI, 1.4-32.3), and active smoking (odds ratio = 4.8; 95% CI, 1.0-21.3). When only wheeze at age 18 years was considered, reduced percentage of predicted V′maxFRC was associated with wheeze at age 18 years only among current smokers (P = .04).Conclusions and Relevance 
                  Wheeze persisting from ages 6 to 18 years is associated with multiple factors, including reduced infant lung function, infant-onset atopy, maternal asthma, and active smoking. Wheeze at age 18 years (regardless of previous wheeze status) is associated with active smoking, but only among those with reduced lung function in infancy. These findings give unique insight into the cause of obstructive airways disease in 18-year-olds, and follow-up of this cohort might be expected to further extend our understanding.