Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children
Evelien R. van Meel, Sara M. Mensink‐Bout, Herman T. den Dekker, Tarunveer S. Ahluwalia, Isabella Annesi‐Maesano, Syed Hasan Arshad, Nour Baïz, Henrique Barros, Andrea von Berg, Hans Bisgaard, Klaus Bønnelykke, Christian J. Carlsson, Maribel Casas, Leda Chatzi, Cécile Chevrier, Geertje W. Dalmeijer, Carol Dezateux, Karel Duchén, Merete Eggesbø, Cornelis van der Ent, Maria Pia Fantini, Claudia Flexeder, Urs Frey, Fransesco Forastiere, Ulrike Gehring, Davide Gori, Raquel Granell, Lucy Griffiths, Hazel Inskip, Joanna Jerzyńska, Anne M. Karvonen, Thomas Keil, Cecily Kelleher, Manolis Kogevinas, Gudrun Koppen, Claudia E. Kuehni, Nathalie Lambrechts, Susanne Lau, Irina Lehmann, Johnny Ludvigsson, Maria C. Magnus, Erik Melén, John Mehegan, Monique Mommers, Anne‐Marie Nybo Andersen, Wenche Nystad, Eva S.L. Pedersen, Juha Pekkanen, Ville Peltola, Katharine C. Pike, Angela Pinot de Moira, Costanza Pizzi, Kinga Polańska, Maja Popović, Daniela Porta, Graham Roberts, Ana Cristina Santos, Erica S. Schultz, Marie Standl, Jordi Sunyer, Carel Thijs, Laura Toivonen, Eleonora Uphoff, Jakob Usemann, Marina Vafeidi, John Wright, Johan C. de Jongste, Vincent W. V. Jaddoe, Liesbeth Duijts
Abstract
Background Early-life respiratory tract infections might affect chronic obstructive respiratory diseases, but conclusive studies from general populations are lacking. Our objective was to examine if children with early-life respiratory tract infections had increased risks of lower lung function and asthma at school age. Methods We used individual participant data of 150 090 children primarily from the EU Child Cohort Network to examine the associations of upper and lower respiratory tract infections from age 6 months to 5 years with forced expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC, forced expiratory flow at 75% of FVC (FEF 75% ) and asthma at a median (range) age of 7 (4–15) years. Results Children with early-life lower, not upper, respiratory tract infections had a lower school-age FEV 1 , FEV 1 /FVC and FEF 75% (z-score range: −0.09 (95% CI −0.14– −0.04) to −0.30 (95% CI −0.36– −0.24)). Children with early-life lower respiratory tract infections had a higher increased risk of school-age asthma than those with upper respiratory tract infections (OR range: 2.10 (95% CI 1.98–2.22) to 6.30 (95% CI 5.64–7.04) and 1.25 (95% CI 1.18–1.32) to 1.55 (95% CI 1.47–1.65), respectively). Adjustment for preceding respiratory tract infections slightly decreased the strength of the effects. Observed associations were similar for those with and without early-life wheezing as a proxy for early-life asthma. Conclusions Our findings suggest that early-life respiratory tract infections affect development of chronic obstructive respiratory diseases in later life, with the strongest effects for lower respiratory tract infections.