Asthma and lower airway disease
Asthma and lung structure on computed tomography: The Multi-Ethnic Study of Atherosclerosis Lung Study

https://doi.org/10.1016/j.jaci.2012.11.036Get rights and content

Background

The potential consequences of asthma in childhood and young adulthood on lung structure in older adults have not been studied in a large, population-based cohort.

Objective

The authors hypothesized that a history of asthma onset in childhood (age 18 years or before) or young adulthood (age 19-45 years) was associated with altered lung structure on computed tomography in later life.

Methods

The Multi-Ethnic Study of Atherosclerosis Lung Study recruited 3965 participants and assessed asthma history by using standardized questionnaires, guideline-based spirometry, and segmental airway dimensions and percentage of low attenuation area (%LAA) on computed tomographic scans.

Results

Asthma with onset in childhood and young adulthood was associated with large decrements in FEV1 among participants with a mean age of 66 years (−365 mL and −343 mL, respectively; P < .001). Asthma with onset in childhood and young adulthood was associated with increased mean airway wall thickness standardized to an internal perimeter of 10 mm (0.1 mm, P < .001 for both), predominantly from narrower segmental airway lumens (−0.39 mm and −0.34 mm, respectively; P < .001). Asthma with onset in childhood and young adulthood also was associated with a greater %LAA (1.69% and 4.30%, respectively; P < .001). Findings were similar among never smokers, except that differential %LAA in childhood-onset asthma were not seen in them.

Conclusion

Asthma with onset in childhood or young adulthood was associated with reduced lung function, narrower airways, and among asthmatic patients who smoked, greater %LAA in later life.

Section snippets

Multi-Ethnic Study of Atherosclerosis

The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of subclinical cardiovascular disease in white, African American, Hispanic, and Asian subjects.22 Between 2000 and 2002, MESA recruited 6814 men and women 45 to 84 years of age from Forsyth County, North Carolina; New York City; Baltimore, Maryland; St Paul, Minnesota; Chicago, Illinois; and Los Angeles, California. Exclusion criteria were clinical cardiovascular disease, weight exceeding 136 kg (300 lb), pregnancy,

Results

The mean age of the 3371 participants was 65 years at the time of spirometry, 49% were male, and the race/ethic distribution was 34% white, 25% African American, 23% Hispanic, and 18% Chinese American. Fifty percent of the cohort never smoked cigarettes, 42% were former smokers, and 8% currently smoked.

Of the 3371 participants who met the inclusion criteria, 446 had asthma, and 2925 did not. Two hundred seventeen participants reported asthma onset in childhood and 102 as young adults.

Discussion

A history of asthma, particularly in childhood and young adulthood, was associated both with large decrements in lung function in later life and narrower segmental airways in this large, population-based cohort study. In addition, asthma onset in young adulthood was associated with increased %LAA.

The mean decrement in FEV1 in later life among participants with asthma with onset in childhood and young adulthood was greater than that among participants with a history of cigarette smoking (−365 mL

References (44)

  • S.S. Salvi et al.

    Chronic obstructive pulmonary disease in non-smokers

    Lancet

    (2009)
  • G.E. Silva et al.

    Asthma as a risk factor for COPD in a longitudinal study

    Chest

    (2004)
  • P. Lange et al.

    A 15-year follow-up study of ventilatory function in adults with asthma

    N Engl J Med

    (1998)
  • H.M. Lee et al.

    Forced vital capacity paired with Framingham Risk Score for prediction of all-cause mortality

    Eur Respir J

    (2010)
  • K.F. Rabe et al.

    Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary

    Am J Respir Crit Care Med

    (2007)
  • Minino AM, Xu J. National Vital Statistics reports: deaths: preliminary data for 20082010 December 16, 2010. Available...
  • M.H. Grol et al.

    Asthma: from childhood to adulthood

    Allergy

    (1996)
  • L.M. van den Toorn et al.

    Airway inflammation is present during clinical remission of atopic asthma

    Am J Respir Crit Care Med

    (2001)
  • C. Svanes et al.

    Early life origins of chronic obstructive pulmonary disease

    Thorax

    (2010)
  • N. Awadh et al.

    Airway wall thickness in patients with near fatal asthma and control groups: assessment with high resolution computed tomographic scanning

    Thorax

    (1998)
  • L. Benayoun et al.

    Airway structural alterations selectively associated with severe asthma

    Am J Respir Crit Care Med

    (2003)
  • H. Gono et al.

    Evaluation of airway wall thickness and air trapping by HRCT in asymptomatic asthma

    Eur Respir J

    (2003)

    • Cited by (0)

    Supported by National Institutes of Health grants R01 HL077612, R01 HL075476, RC1 HL100543, and N01-HC95159-169. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    Disclosure of potential conflict of interest: K. M. Donohue has received grants from the National Institutes of Health (NIH) and the Alpha One Foundation, has received travel support from the NIH, and is employed by Columbia University. E. A. Hoffman has received grants from the NIH and is a founder and shareholder of VIDA Diagnostics, a company commercializing lung image analysis software developed, in part, at the University of Iowa. H. Baumhauer has received grants and travel support from the University of Iowa. J. Guo has received grants from the NIH and is a shareholder in VIDA Diagnostics. D. R. Jacobs and P. Enright have received grants from the NIH. R. G. Barr has received grants from the NIH, has received royalties from UpToDate, and has received travel support from Boehringer Ingelheim. The rest of the authors declare that they have no relevant conflicts of interest.

    View full text
    Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.