Effects of Pneumonia and Pertussis in Childhood on Adult Pulmonary Function
ABSTRACT & COMMENTARY
Synopsis: Childhood pneumonia is associated with reduced ventilatory function in adult life. A history of whooping cough in childhood did not have a significant effect on adult pulmonary function.
Source: Johnston IDA, et al. Effect of pneumonia and whooping cough in childhood on adult lung function. N Engl J Med 1998;338:581-587.
Previous studies have suggested that respiratory infection in childhood may be associated with respiratory disease in adult life, but the link is unclear because of retrospective ascertainment of childhood infection, selection bias, and other confounding factors. Johnston and associates investigated a large cohort of people entered in the British National Childhood Development Study who were born in the same week in March 1958 and have been regularly followed for nearly 35 years. A sample of 1392 of these subjects were studied. Of these, 193 had a history of pneumonia, and 215 had a history of pertussis before the age of 7 years. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were measured before and after inhalation of albuterol. These subjects were compared to a randomly selected control group from the same cohort who had no history of childhood pneumonia or pertussis. A history of childhood pneumonia was associated with significant deficits in both FEV1 (102 ± 73 mL) and FVC (173 ± 70 mL). Deficits associated with whooping cough were smaller and not significant. The findings were independent of a history of wheezing or asthma.
COMMENT BY THOMAS F. DOLAN, MD, FAAP
Johnston et al studied follow-up of 1392 British adults from their birth in 1958. One hundred ninety-three had a history of pneumonia, and 250 had a history of whooping cough before their seventh birthday. The diagnosis was made by obtaining a history at age 7 of either diagnoses but was not substantiated.
When pulmonary function tests were performed at age 34-35 years, there was a significant decrease in FVC and FEV1 in the subjects who had pneumonia. Deficits persisted after albuterol inhalation. There was less deficit in patients with a history of past or present wheezing. There was more of a difference if pneumonia occurred before 2 years of age than between 2 and 7 years. Most new alveoli are produced in the first two years. Deficits associated with whooping cough were only marginal.
Johnston et al conclude that pneumonia in childhood reduces lung function in adults independent of a history of wheezing or other confounding factors. Other authors have suggested that childhood lower respiratory tract infections reduced adult lung function, but only one reported lung function in young adults.1
The Arizona Tucson Children's Respiration Study assessed risk factors for acute and chronic lung diseases in infants recruited at birth.2 Sophisticated pulmonary functions tests include conductance, Vmax at FRC, and the Tme/TF (time to reach maximum stance of total expiration flow before maximum flow attained).
They showed that small lung volumes (particularly in girls) decreased Tme, and decreased conductance was associated with marked increase in wheezing in the first year. They also suggest that small airways predispose to infection. These small airways possibly persist and lead to decreased lung function in adults. Only a few of the Arizona patients had lower respiratory tract disease without wheezing, and, in these, there was no evidence of small lungs. Perhaps a larger series will show evidence of abnormalities.
It is not surprising to me that patients with pertussis had only marginal late-term effects. Pertussis is an unusual disease. The bacteria don't exclusively attach to and damage cilia of respiration epithelium. In general, there is no pneumonia unless there is a secondary infection, no wheezing, and no systemic effects unless the patient is cyanotic.
Pulmonary function testing in newborns is feasible but is time consuming and requires high-tech personnel and equipment. Further long-term studies of infants are needed. (Dr. Dolan is Professor of Pediatrics-Respiratory Medicine, Yale University School of Medicine.)
References
1. Britten N, et al. Early respiratory experience and subsequent cough and peak expiration flow rate in 36 year-old men and women. BMJ 1987;294:1317-1320.
2. Martinez FD, et al. Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. N Engl J Med 1988;319:1112-1117.
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