NEW research shows that individuals with impaired lung function trajectories experience a higher burden of respiratory symptoms, including wheeze and phlegm, even if they do not meet the spirometric criteria for chronic obstructive pulmonary disease (COPD).
Researchers analysed life-course lung function and respiratory symptom data from two large, population-based cohort studies: the Tasmanian Longitudinal Health Study (TAHS) in Australia and the Coronary Artery Risk Development in Young Adults (CARDIA) study in the USA. Participants were followed from childhood or early adulthood into their 50s. Symptom profiles at ages 53 and 55 were identified using latent class analysis and compared across pre-bronchodilator FEV1/FVC trajectories derived from group-based modelling. The analysis was further restricted to individuals without COPD, defined as post-bronchodilator FEV1/FVC below the 5th percentile.
Across both cohorts, six distinct lung function trajectories were identified. The most impaired trajectory, characterised by early low lung function and rapid decline, was strongly associated with respiratory symptoms. Individuals on these trajectories had significantly higher odds of predominant wheeze (multinomial odds ratio [mOR]: 6.71, 95% CI: 4.10–10.90 in TAHS; 9.90, 95% CI: 4.52–21.70 in CARDIA) and nearly all respiratory symptoms (mOR: 4.95, 95% CI: 2.52–9.74 in TAHS; 14.80, 95% CI: 5.97–36.60 in CARDIA) compared with those on average lung function trajectories.
Among those with the most impaired lung function, wheeze severity worsened with greater FEV1/FVC decline, even when excluding individuals with spirometry-defined COPD. Additionally, 20% of participants in TAHS who had rapid lung function decline reported both wheezing and usual phlegm or bronchitis before age 14, and 25% of those in CARDIA reported these symptoms before age 30.
These findings highlight the long-term impact of early lung function impairment, emphasising the need for early recognition and intervention in individuals at risk of persistent respiratory symptoms, even before COPD develops.
Ada Enesco, EMJ
Reference
Perret JL et al; AUSCULTATE investigator group. Associations between life-course FEV1/FVC trajectories and respiratory symptoms up to middle age: analysis of data from two prospective cohort studies. Lancet Respir Med. 2025;13(2):130-140.
