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, Þórarinn Gíslason, 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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 (FEV1) 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 FEV1/FVC≥LLN and FVC<10th percentile, obstructive if FEV1/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
Pages (from-to)153-162
Number of pages10
Issue number2
Publication statusPublished - Jan 2024

Bibliographical note

Funding Information:
This work was supported by FIS award PS09/01354 from the Instituto de Salud Carlos III. We acknowledge support from the Spanish Ministry of Science and Innovation through the ‘Centro de Excelencia Severo Ochoa 2019-2023’ Programme (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Programme. The funding agencies and principal investigators for the European Community Respiratory Health Survey are reported in the online supplemental appendix 1. The funding source had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Other keywords

  • Clinical Epidemiology
  • COPD epidemiology


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