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.
Bibliographical noteFunding Information:
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.
- Airway remodeling
- airway structure