Plasticity of Individual Lung Function States from Childhood to Adulthood

Gang Wang, Jenny Hallberg, Rosa Faner, Hans Jacob Koefoed, Simon Kebede Merid, Susanna Klevebro, Sophia Bjorkander, Olena Gruzieva, Goran Pershagen, Marianne van Hage, Stefano Guerra, Matteo Bottai, Antonios Georgelis, Ulrike Gehring, Anna Bergstrom, Judith M. Vonk, Inger Kull, Gerard H. Koppelman, Alvar Agusti, Erik Melen

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Rationale: Recent evidence highlights the importance of optimal lung development during childhood for health throughout life. Objectives: To explore the plasticity of individual lung function states during childhood. Methods: Prebronchodilator FEV1 z-scores determined at age 8, 16, and 24 years in the Swedish population-based birth cohort BAMSE (Swedish abbreviation for Child [Barn], Allergy, Milieu, Stockholm, Epidemiological study) (N = 3,069) were used. An unbiased, data-driven dependent mixture model was applied to explore lung function states and individual state chains. Lung function catch-up was defined as participants moving from low or very low states to normal or high or very high states, and growth failure as moving from normal or high or very high states to low or very low states. At 24 years, we compared respiratory symptoms, small airway function (multiple-breath washout), and circulating inflammatory protein levels, by using proteomics, across states. Models were replicated in the independent Dutch population-based PIAMA (Prevention and Incidence of Asthma and Mite Allergy) cohort. Measurements and Main Results: Five lung function states were identified in BAMSE. Lung function catch-up and growth failure were observed in 74 (14.5%) BAMSE participants with low or very low states and 36 (2.4%) participants with normal or high or very high states, respectively. The occurrence of catch-up and growth failure was replicated in PIAMA. Early-life risk factors were cumulatively associated with the very low state, as well as with catch-up (inverse association) and growth failure. The very low state as well as growth failure were associated with respiratory symptoms, airflow limitation, and small airway dysfunction at adulthood. Proteomics identified IL-6 and CXCL10 (C-X-C motif chemokine 10) as potential biomarkers of impaired lung function development. Conclusions: Individual lung function states during childhood are plastic, including catch-up and growth failure.

Original languageEnglish (US)
Pages (from-to)406-415
Number of pages10
JournalAmerican journal of respiratory and critical care medicine
Issue number4
StatePublished - Feb 15 2023


  • asthma
  • early life risk factors
  • inflammation
  • multiple-breath washout
  • respiratory health

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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