General population-based lung function trajectories over the life course: an accelerated cohort study

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  • dc.contributor.author García Aymerich, Judith
  • dc.contributor.author de las Heras, Martí
  • dc.contributor.author Carsin, Anne-Elie
  • dc.contributor.author Koch, Sarah
  • dc.contributor.author Faner, Rosa
  • dc.date.accessioned 2025-07-25T06:18:33Z
  • dc.date.available 2025-07-25T06:18:33Z
  • dc.date.issued 2025
  • dc.description.abstract Background: Lung function is a key determinant of health, but current knowledge on lung function growth and decline over the life course is based on fragmented, potentially biased data. We aimed to empirically derive general population-based life course lung function trajectories, and to identify breakpoints and plateaus. Methods: We created an accelerated cohort by pooling data from eight general population-based child and adult cohort studies from Europe and Australia. We included all participants with information on lung function, smoking status, BMI, and asthma diagnosis status from at least two visits. We used cross-classified three-level linear mixed models to derive sex-specific life course trajectories of FEV1, forced vital capacity (FVC), and FEV1/FVC ratio based on observations at ages 4-80 years, and Bayesian time-series decomposition to identify breakpoints and plateaus. We repeated sex-specific analyses with separate stratification for asthma status (never had asthma vs persistent asthma, where persistent was defined as the risk factor being present at all participant visits) and smoking status (never smoker vs persistent smoker). Findings: The accelerated cohort included 30 438 participants born between 1901 and 2006 (15 703 [51·6%] female and 14 735 [48·4%] male; mean age 26 [SD 16] years), who provided a total of 87 666 observations (range 2-8 observations per participant). In female participants, FEV1 increased non-linearly in two phases, at a mean of 234 (95% CI 223 to 245) mL/year until age 13 (95% credible interval [CrI] 12 to 15) years, then at 99 (76 to 122) mL/year until a peak at age 20 (18 to 22) years, and subsequently decreased throughout the rest of adulthood (-26 [-27 to -25] mL/year). In male participants, the pattern was similar, with an increase in FEV1 of 271 (263 to 280) mL/year until age 16 (14 to 18) years, which slowed to 108 (93 to 124) mL/year until reaching a maximum at age 23 (21 to 25) years, decreasing thereafter (-38 [-39 to -37] mL/year), representing a later peak than in female participants. In female participants, FVC increased non-linearly in two phases, at 232 (95% CI 222 to 243) mL/year until age 14 (95% CrI 12 to 15) years, then at 77 (59 to 94) mL/year until peaking at age 20 (19 to 22) years, after which it decreased throughout the rest of adulthood (-26 [-27 to -25] mL/year). In male participants, FVC also increased in two phases, at 326 (315 to 337) mL/year until age 15 (13 to 17) years, then at 156 (144 to 168) mL/year until a peak at 23 (19 to 30) years, and subsequently declined in two phases (-22 [-29 to -14] mL/year until age 42 [38 to 50] years, then -36 [-38 to -34] mL/year thereafter). No plateau after the peak was observed for either lung function parameter in both sexes. FEV1/FVC ratio decreased throughout life from the starting age of 4 years in both sexes with some distinct patterns. Stratified analysis showed that persistent asthma (vs never had asthma) was related to an earlier FEV1 peak, lower FEV1 throughout adulthood, and lower FEV1/FVC ratio across the life course in both sexes. Persistent smoking (vs never smoking) was related to an accelerated decrease in FEV1 and FEV1/FVC ratio during adulthood in both sexes. No statistically significant plateau was observed in any lung function parameter across the strata of asthma or smoking status. Interpretation: In both sexes, FEV1 and FVC increased in two phases, with a fast increase until around age 13-16 years, and then a slower increase until a peak. Neither parameter showed a plateau phase after the peak, and decreases started earlier than previously described. FEV1/FVC ratio decreased throughout life. These observations provide an essential, but previously unavailable, framework to assess and monitor lung health over the life course. Funding: EU Horizon 2020, Wellcome, European Respiratory Society, AstraZeneca, Chiesi, GSK, Menarini Group, and Sanofi.
  • dc.description.sponsorship Management of University and Research Grants (grant numbers 2009 SGR 501 and 2014 SGR 822), Fundació La Marató de TV3 (grant number 090430), the Spanish Ministry of Economy and Competitiveness (grant number SAF2012-32991 including FEDER funding), Agence Nationale de Securite Sanitaire de l’Alimentation de l’Environnement et du Travail (grant numbers 1262C0010, EST-2016 RF-21, EST-19 RF-04, and 2019/1/233), and the European Commission (grant numbers 261357, 308333, 603794, 634453, 825712, and 874583). INMA Valencia was funded by grants from the EU (grant numbers FP7-ENV-2011 cod 282957, HEALTH.2010.2.4.5-1, cod 874583, and cod 101136566), Instituto de Salud Carlos III (grant numbers G03/176, FIS-FEDER, PI03/1615, PI04/1509, PI06/1213, PI11/01007, PI11/02591, PI11/02038, PI12/00610, PI13/1944, PI13/2032, PI14/00891, PI14/01687, PI16/1288, PI17/00663, PI19/1338, and P 23/1578), Miguel Servet-FEDER (grant numbers CP11/00178, CP15/00025, MSII16/00051, and MS20/0006), the Spanish Ministry of Universities (Margarita Salas Grant MS21-133 and grant CAS21/00008), Generalitat Valenciana (grant numbers CIAICO/2021/132, BEST/2020/059, AICO 2020/285, and AICO/2021/182), Consejo General de Enfermería (grant number PNI22_CGE45), FISABIO (grant numbers UGP 15-230, UGP-15-244, and UGP-15-249), and the Alicia Koplowitz Foundation 2017. The PIAMA study was supported by the Netherlands Organization for Health Research and Development, the Netherlands Organization for Scientific Research, the Netherlands Asthma Fund, the Netherlands Ministry of Spatial Planning, Housing, and the Environment, the Netherlands Ministry of Health, Welfare, and Sport, and the Netherlands National Institute for Public Health and the Environment. SAPALDIA was funded by the Swiss National Science Foundation (grant numbers 33CS30-177506/1, 33CS30-148470/1&2, 33CSCO-134276/1, 33CSCO-108796, 324730_135673, 3247BO-104283, 3247BO-104288, 3247BO-104284, 3247-065896, 3100-059302, 3200-052720, 3200-042532, 4026-028099, PMPDP3_129021/1, and PMPDP3_141671/1), the Swiss Federal Office for the Environment, the Swiss Federal Office of Public Health, the Swiss Federal Office of Roads and Transport, the Canton's Governments of Aargau, Basel-Stadt, Basel-Land, Geneva, Luzern, Ticino, Valais, and Zürich, the Swiss Lung League, the Canton's Lung Leagues of Basel Stadt/Basel Landschaft, Geneva, Ticino, Valais, Graubünden, and Zurich, Stiftung ehemals Bündner Heilstätten, Swiss National Accident Insurance Fund, Freiwillige Akademische Gesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics, Abbott Diagnostics, the European Commission (GABRIEL study, grant number 018996), Wellcome (grant number WT 084703MA), and an Exposomics European Commission FP7 grant (grant agreement number 308610). TAHS was supported by the National Health and Medical Research Council (NHMRC) of Australia under the NHMRC project grant scheme (grant numbers 299901 and 1021275) and the NHMRC European collaborative grant scheme (grant number 1101313) as part of the ALEC Study, funded by the EU's Horizon 2020 research and innovation programme under grant agreement number 633212. TAHS was also supported by the University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, the Asthma Foundations of Victoria, Queensland, and Tasmania, the Royal Hobart Hospital, Helen MacPherson Smith Trust, and GSK. The VlaVla study did not have external funding. The current study was funded by the EU's Horizon 2020 research and innovation programme (ALEC Study, grant agreement number 633212), Wellcome (grant reference 217065/Z/19/Z), and the European Respiratory Society Chronic Airway Diseases Early Stratification Clinical Research Collaboration, with the collaboration of AstraZeneca, Chiesi, GSK, Menarini Group, and Sanofi. MdlH was funded by NextGenerationEU, under Program Investigo (INVESTIGO 2022, Agency for Management of University and Research Grants). SCD, JP, and EHW are supported by the NHMRC of Australia. JWD is supported by the NIHR Bristol Biomedical Research Centre (grant number NIHR203315). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ISGlobal acknowledges support from the grant CEX2018-000806-S funded by the Spanish Ministry of Science, Innovation, and Universities and Spanish State Research Agency, and from the Government of Catalonia through the CERCA Programme.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Garcia-Aymerich J, de Las Heras M, Carsin AE, Accordini S, Agustí A, Bui D, et al. General population-based lung function trajectories over the life course: an accelerated cohort study. Lancet Respir Med. 2025 Jul;13(7):611-22. DOI: 10.1016/S2213-2600(25)00043-8
  • dc.identifier.doi http://dx.doi.org/10.1016/S2213-2600(25)00043-8
  • dc.identifier.issn 2213-2600
  • dc.identifier.uri http://hdl.handle.net/10230/70998
  • dc.language.iso eng
  • dc.publisher Elsevier
  • dc.relation.ispartof Lancet Respir Med. 2025 Jul;13(7):611-22
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/757919
  • dc.relation.projectID info:eu-repo/grantAgreement/ES/3PN/SAF2012-32991
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/261357
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/308333
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/603794
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/282957
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/308610
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/634453
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/825712
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/874583
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/633212
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/HE/101136566
  • dc.rights © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license (http://creativecommons.org/licenses/by/4.0/).
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.other Pulmons
  • dc.title General population-based lung function trajectories over the life course: an accelerated cohort study
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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Articles (Departament de Medicina i Ciències de la Vida)
Articles (Barcelona Institute for Global Health (ISGlobal) – Campus Mar)
Documents OpenAIRE (Open Access Infrastructure for Research in Europe)