Asthma/COPD Overlap Associated with Lung Function in Childhood

Children with the lowest level of lung function had an increased risk for developing asthma- chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), according to a recent study.

The study included a cohort of 8583 children and a subcohort of 1389 children. Children were recruited at 7 years of age in 1968 and underwent prebronchodilator spirometry at baseline. In addition, the subcohort underwent both prebronchodilator and post-bronchodilator spirometry. All participants were resurveyed at 45 years.
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Associations between childhood lung function and the development of asthma, COPD, and ACOS were examined. COPD was defined as the post-bronchodilator forced expiratory volume at the first seconds of forced breath (FEV1) and forced vital capacity (FVC) less than the lower limit of normal, and ACOS was defined as the coexistence of COPD and current asthma symptoms.

Overall, 68 participants had ACOS, 269 had current asthma, 59 had COPD, and 959 did not have asthma or COPD after 45 years. The reweighted prevalence of asthma was 13.5%, COPD was 4.1%, and ACOs was 2.9%.

ACOS was associated with the lowest quartile of FEV1 at 7 years of age, but not COPD or asthma (odds ratio [OR] 2.93). Likewise, ACOS and COPD were associated with the lowest quartile of FEV1/ FVC ratio at 7 years of age (OR 16.3 and 5.76, respectively), but not asthma.

“Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention.”

“Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function.”

—Melissa Weiss


Bui DS, Burgess JA, Lowe AJ, et al. Childhood lung function predicts adult chronic obstructive pulmonary disease and asthma–chronic obstructive pulmonary disease overlap syndrome [published online July 1, 2017]. Am J Respir Crit Care Med.