Knowledge about long-term variability of lung function in healthy children is essential when moni... more Knowledge about long-term variability of lung function in healthy children is essential when monitoring and treating those with respiratory disease over time. The aim of this study was to define the natural variability in spirometry in young children after an interval of 12 months.The Size and Lung function In Children study was a prospective study designed to assess spirometry and body size, shape and composition in a multi-ethnic population of London school children. 14 schools with a wide range of socioeconomic circumstances were recruited. Spirometric and anthropometric assessments and parental questionnaires pertaining to respiratory symptoms, previous medical history, pubertal status and socioeconomic circumstances were completed at baseline and ∼1 year later.Technically acceptable spirometry data on two occasions ∼1 year apart (range 9-16 months) were available in 758 children (39% boys, mean±sdage 8.1±1.6 years), 593 of whom were classified as "healthy". Mean±sdwithin-subject between-test variability was 0.05±0.6 z-scores, with 95% of all the children achieving a between-test variability within ±1.2 z-scores (equating to ∼13% predicted).Natural variations of up to 1.2 z-scores occur in healthy children over ∼1 year. These must be considered when interpreting results from annual reviews in those with lung disease who are otherwise stable, if unnecessary further investigations or changes in treatment are to be avoided.
Spirometry datasets from South-Asian children were collated from four centres in India and five w... more Spirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110). Following exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5-17 years). When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1) and forced vital capacity (FVC) in South-Asian children were on average 15% lower, ranging from 4-19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The 'GLI-Other' equation fitted data from North India reasonably well while 'GLI-Black' equations provided a better approximation for South-Asian data than the 'GLI-White' equation. However, marked discrepancies in the mean lung function z-scores between centres especially...
American Journal of Respiratory and Critical Care Medicine, Sep 1, 2004
This study aimed to compare lung growth and development during the first year of life in healthy ... more This study aimed to compare lung growth and development during the first year of life in healthy term infants of low or appropriate birth weight for gestation. Paired measurements of forced expiratory volume in 0.4 second, FVC, and forced expiratory flow when 75% of FVC has been exhaled were obtained, using the raised volume technique, at about 7 weeks and 9 months of age in 80 infants (32 low and 48 appropriate birth weight for gestation) of white, nonsmoking mothers. Forced flows and volumes increased with growth. Longitudinal trends in results were compared between the two groups, using random effects modeling and adjusted for potential confounding factors. After adjustment for sex, age, and length, forced expiratory volume was significantly reduced by an average (95% confidence interval) of 9% (2 to 16%) in low birth weight compared with appropriate birth weight for gestation infants throughout the first year of life, with a similar trend in forced expiratory flow (8% [-2 to 17%]) and FVC (4% [-3 to 11%]). These findings suggest that lung function is reduced in low birth weight for gestation infants born to nonsmoking white mothers and that this is independent of somatic growth during infancy.
Infants who are small for gestational age (SGA) are at increased risk of respiratory morbidity an... more Infants who are small for gestational age (SGA) are at increased risk of respiratory morbidity and mortality. However, the physiological mechanisms underlying these associations remain unclear and information is lacking regarding the effect of low birthweight for gestational age on airway function soon after birth.
Background: Poor fetal growth has been associated with impaired airway function in adult life, bu... more Background: Poor fetal growth has been associated with impaired airway function in adult life, but evidence linking birth weight and airway function in early childhood is sparse. We examined the hypothesis that low birth weight for gestation is associated with impaired airway function shortly after birth and that this is independent of impaired postnatal somatic growth. Methods: Airway function was measured using the raised volume technique in healthy white infants of low ((10th centile) or appropriate (>20th centile) birth weight for gestation and was expressed as forced expiratory volume in 0.4 s (FEV 0.4 ), forced vital capacity (FVC), and the maximal expired flow at 25% of forced vital capacity (MEF 25 ). Infant length and weight, maternal height and weight, maternal report of smoking prenatally and postnatally, and parental occupation were recorded. Results: Mothers of low birth weight for gestation infants (n = 98) were lighter, shorter, and more likely to smoke and have partners in manual occupations. At 6 weeks their infants remained lighter and shorter than those of appropriate birth weight (n = 136). FEV 0.4 , FVC, and MEF 25 were reduced in infants of low birth weight for gestation, in those whose mothers smoked in pregnancy, or who were in manual occupations. After adjusting for relevant maternal and infant characteristics, infants in the low birth weight for gestation group experienced a mean reduction of 11 ml in FEV 0.4 (95% CI 4 to 18; p = 0.002), of 12 ml in FVC (95% CI 4 to 19; p = 0.004), and of 28 ml/s in MEF 25 (95% CI 7 to 48; p = 0.03). Conclusions: Airway function is diminished in early postnatal life as a consequence of a complex causal pathway which includes social disadvantage as indicated by maternal social class, smoking and height, birth weight as a proximal and related consequence of these factors, and genetic predisposition to asthma. Further work is needed to establish the relevance of these findings to subsequent airway growth and development in later infancy and early childhood.
Pediatric Allergy, Immunology, and Pulmonology, 2011
... magnetic resonance. Am J Respir Crit Care Med 2006; 173:847851. 56. Maritz GS, Morley CJ, Ha... more ... magnetic resonance. Am J Respir Crit Care Med 2006; 173:847851. 56. Maritz GS, Morley CJ, Harding R. Early developmental origins of impaired lung structure and function. Early Hum Dev 2005; 81:763771. 57. Filippone ...
Knowledge about long-term variability of lung function in healthy children is essential when moni... more Knowledge about long-term variability of lung function in healthy children is essential when monitoring and treating those with respiratory disease over time. The aim of this study was to define the natural variability in spirometry in young children after an interval of 12 months.The Size and Lung function In Children study was a prospective study designed to assess spirometry and body size, shape and composition in a multi-ethnic population of London school children. 14 schools with a wide range of socioeconomic circumstances were recruited. Spirometric and anthropometric assessments and parental questionnaires pertaining to respiratory symptoms, previous medical history, pubertal status and socioeconomic circumstances were completed at baseline and ∼1 year later.Technically acceptable spirometry data on two occasions ∼1 year apart (range 9-16 months) were available in 758 children (39% boys, mean±sdage 8.1±1.6 years), 593 of whom were classified as "healthy". Mean±sdwithin-subject between-test variability was 0.05±0.6 z-scores, with 95% of all the children achieving a between-test variability within ±1.2 z-scores (equating to ∼13% predicted).Natural variations of up to 1.2 z-scores occur in healthy children over ∼1 year. These must be considered when interpreting results from annual reviews in those with lung disease who are otherwise stable, if unnecessary further investigations or changes in treatment are to be avoided.
Spirometry datasets from South-Asian children were collated from four centres in India and five w... more Spirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110). Following exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5-17 years). When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1) and forced vital capacity (FVC) in South-Asian children were on average 15% lower, ranging from 4-19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The 'GLI-Other' equation fitted data from North India reasonably well while 'GLI-Black' equations provided a better approximation for South-Asian data than the 'GLI-White' equation. However, marked discrepancies in the mean lung function z-scores between centres especially...
American Journal of Respiratory and Critical Care Medicine, Sep 1, 2004
This study aimed to compare lung growth and development during the first year of life in healthy ... more This study aimed to compare lung growth and development during the first year of life in healthy term infants of low or appropriate birth weight for gestation. Paired measurements of forced expiratory volume in 0.4 second, FVC, and forced expiratory flow when 75% of FVC has been exhaled were obtained, using the raised volume technique, at about 7 weeks and 9 months of age in 80 infants (32 low and 48 appropriate birth weight for gestation) of white, nonsmoking mothers. Forced flows and volumes increased with growth. Longitudinal trends in results were compared between the two groups, using random effects modeling and adjusted for potential confounding factors. After adjustment for sex, age, and length, forced expiratory volume was significantly reduced by an average (95% confidence interval) of 9% (2 to 16%) in low birth weight compared with appropriate birth weight for gestation infants throughout the first year of life, with a similar trend in forced expiratory flow (8% [-2 to 17%]) and FVC (4% [-3 to 11%]). These findings suggest that lung function is reduced in low birth weight for gestation infants born to nonsmoking white mothers and that this is independent of somatic growth during infancy.
Infants who are small for gestational age (SGA) are at increased risk of respiratory morbidity an... more Infants who are small for gestational age (SGA) are at increased risk of respiratory morbidity and mortality. However, the physiological mechanisms underlying these associations remain unclear and information is lacking regarding the effect of low birthweight for gestational age on airway function soon after birth.
Background: Poor fetal growth has been associated with impaired airway function in adult life, bu... more Background: Poor fetal growth has been associated with impaired airway function in adult life, but evidence linking birth weight and airway function in early childhood is sparse. We examined the hypothesis that low birth weight for gestation is associated with impaired airway function shortly after birth and that this is independent of impaired postnatal somatic growth. Methods: Airway function was measured using the raised volume technique in healthy white infants of low ((10th centile) or appropriate (>20th centile) birth weight for gestation and was expressed as forced expiratory volume in 0.4 s (FEV 0.4 ), forced vital capacity (FVC), and the maximal expired flow at 25% of forced vital capacity (MEF 25 ). Infant length and weight, maternal height and weight, maternal report of smoking prenatally and postnatally, and parental occupation were recorded. Results: Mothers of low birth weight for gestation infants (n = 98) were lighter, shorter, and more likely to smoke and have partners in manual occupations. At 6 weeks their infants remained lighter and shorter than those of appropriate birth weight (n = 136). FEV 0.4 , FVC, and MEF 25 were reduced in infants of low birth weight for gestation, in those whose mothers smoked in pregnancy, or who were in manual occupations. After adjusting for relevant maternal and infant characteristics, infants in the low birth weight for gestation group experienced a mean reduction of 11 ml in FEV 0.4 (95% CI 4 to 18; p = 0.002), of 12 ml in FVC (95% CI 4 to 19; p = 0.004), and of 28 ml/s in MEF 25 (95% CI 7 to 48; p = 0.03). Conclusions: Airway function is diminished in early postnatal life as a consequence of a complex causal pathway which includes social disadvantage as indicated by maternal social class, smoking and height, birth weight as a proximal and related consequence of these factors, and genetic predisposition to asthma. Further work is needed to establish the relevance of these findings to subsequent airway growth and development in later infancy and early childhood.
Pediatric Allergy, Immunology, and Pulmonology, 2011
... magnetic resonance. Am J Respir Crit Care Med 2006; 173:847851. 56. Maritz GS, Morley CJ, Ha... more ... magnetic resonance. Am J Respir Crit Care Med 2006; 173:847851. 56. Maritz GS, Morley CJ, Harding R. Early developmental origins of impaired lung structure and function. Early Hum Dev 2005; 81:763771. 57. Filippone ...
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