Spirometric patterns in young and middle-aged adults: A 20-year European study

Anne Elie Carsin, Judith Garcia-Aymerich, Simone Accordini, Shyamali Dharmage, Bénédicte Leynaert, Marti De Las Heras, Lidia Casas, Seraina Caviezel, Pascal Demoly, Bertil Forsberg, Thorarinn Gislason, Angelo Guido Corsico, Christer Janson, Rain Jogi, Jesús Martínez-Moratalla, Dennis Nowak, Leopoldo Palacios Gómez, Isabelle Pin, Nicole Probst-Hensch, Chantal Raherison-SemjenGiulia Squillacioti, Cecilie Svanes, Kjell Torén, Isabel Urrutia, Ismael Huerta, Josep Maria Anto, Debbie Jarvis, Stefano Guerra

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background Understanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of restrictive and obstructive spirometric patterns occurring before 40 years (young onset) and between 40 and 61 years (mid-adult onset). Methods We used data from the population-based cohort of the European Community Respiratory Health Survey (ECRHS). Prebronchodilator forced expiratory volume in one second (FEV 1) and forced vital capacity (FVC) were assessed longitudinally at baseline (ECRHS1, 1993-1994) and again 20 years later (ECRHS3, 2010-2013). Spirometry patterns were defined as: restrictive if FEV 1 /FVC≥LLN and FVC<10th percentile, obstructive if FEV 1 /FVC<LLN or normal otherwise. Five spirometry patterns were derived depending on whether participants never developed restrictive/obstructive (normal), developed restrictive/obstructive at baseline (young onset) or at last follow-up (mid-adult onset). The characteristics and risk factors associated with these patterns were described and assessed using multilevel multinomial logistic regression analysis adjusting for age, sex, sample (random or symptomatic) and centre. Results Among 3502 participants (mean age=30.4 (SD 5.4) at ECRHS1, 50.4 (SD 5.4) at ECRHS3), 2293 (65%) had a normal, 371 (11%) a young restrictive, 301 (9%) a young obstructive, 187 (5%) a mid-adult onset restrictive and 350 (10%) a mid-adult onset obstructive spirometric pattern. Being lean/underweight in childhood and young adult life was associated with the occurrence of the young spirometric restrictive pattern (relative risk ratio (RRR)=1.61 95% CI=1.21 to 2.14, and RRR=2.43 95% CI=1.80 to 3.29; respectively), so were respiratory infections before 5 years (RRR=1.48, 95% CI=1.05 to 2.08). The main determinants for young obstructive, mid-adult restrictive and mid-adult obstructive patterns were asthma, obesity and smoking, respectively. Conclusion Spirometric patterns with onset in young and mid-adult life were associated with distinct characteristics and risk factors.

Original languageEnglish (US)
Pages (from-to)153-162
Number of pages10
Issue number2
StatePublished - Sep 27 2023


  • COPD epidemiology
  • Clinical Epidemiology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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