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Early-life risk factors that lead to poorer adult lung health


Dr. Stefano Guerra, one of the lead researchers of this study, is a professor of medicine in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the University of Arizona College of Medicine and director of the Population Science Unit at the Asthma and Airway Disease Research Center. (Courtesy of Dr. Stefano Guerra).

A recent University of Arizona study found that the three significant risk factors that are associated with adult spirometric restriction were small birth weight for gestational age, maternal nutritional problems during pregnancy and being underweight in childhood. 

Spirometry is a test used to examine the quality of lung function by measuring the amount of air inhaled and exhaled as well as how quickly one exhales. When the spirometry pattern is restrictive, it means that a person is unable to completely fill their lungs with air. 

Dr. Stefano Guerra is one of the lead researchers of this study. Guerra is the director of the Population Science Unit at the University of Arizona Health Sciences Asthma and Airway Disease Research Center.

Guerra and his team collected and analyzed data from multiple existing birth cohorts. His cohort is called the Tucson Children’s Respiratory Study. He also worked alongside two other cohorts — one in Great Britain and the other in Sweden. He explained a birth cohort as a study in which data is collected from participants who are tracked from infancy to adulthood. By working with all three cohorts, he was able to confirm the risk factors for spirometric restriction.

“Our cohort started in 1980 … so participants now are essentially turning 40, and they’ve been followed for 40 years plus,” Guerra said. “We [took those who] developed the spirometric restriction as adults and then we looked back at risk factors in their early life to see what factors in infancy or childhood predicted the onset of this respiratory pattern.” 

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When discussing further research on poor lung health, Guerra said that there is a high probability that preterm babies have similar respiratory health as infants with low birth weight for gestational age. 

Gestational age, measured in weeks, is used to describe how far along a pregnancy is. Normal pregnancies usually range from 38 to 42 weeks.

“You can have a low birth weight, either because the pregnancy didn’t last long enough, so you are premature … [or there’s an] indication of fetal growth restriction. [These babies] didn’t develop to their full size even though they had sufficient time in order to do so, because something happened during pregnancy. One of the things that happened we believe is maternal nutritional problems,” Guerra said.

Guerra said he and his colleagues are looking to perform more research in countries like India that have high rates of poverty. 

“In the US, the prevalence of spirometric restriction in adults is about 10%, but in some areas in India, the prevalence is over 60%. So it’s 6 times higher, and I suspect maternal and child malnutrition may be one explanation for this remarkably high prevalence in those countries.” Guerra said.

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Regarding future research, Guerra believes it’s important to start studying how genetics relates to lung health.

“There are factors that, at least at the present time, we have no control over. Part of this, I think [is because your lung function] is genetically determined. Generally, that’s where we should go next,” Guerra said. “We should try to identify the biology of this abnormal lung growth and try to see if there are rooms for intervention to try to make these children catch-up [to a normal and healthy lung growth].” 

Guerra explained that the genetics for spirometric restriction are largely unknown. However, they are currently studying the proteins that are involved in poor lung function, specifically, a protein called the club cell secretory protein (CC16). One of the functions of the protein is to protect your lungs, so researchers are studying to see if this protein can help children develop healthier lungs and have a healthier lung trajectory. 

Guerra mentioned how individuals with spirometric restriction also struggle with respiratory health, having a lower quality of life and pulmonary disease. Furthermore, the research by the cohorts also indicates that spirometric restriction is associated with an increase in developing comorbidities like cardiovascular disease and diabetes. 

“We really don’t know the reasons for the association between spirometric restriction and comorbidities, but these impaired developmental trajectories that impact the lungs [could also be impacting] other organs, including your cardiovascular system,” Guerra said.

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In terms of prevention, Guerra highlighted the significance of a healthy pregnancy and the importance of raising children in a healthy environment. This includes proper nutrition during pregnancy, avoidance of smoking and drinking during pregnancy and receiving prenatal care. In addition to this, it is important to ensure that the child develops in an atmosphere with high air quality and low levels of pollution and that the child is eventually involved with regular physical activity and receiving adequate nutrition. 

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