Elsevier

Maturitas

Volume 153, November 2021, Pages 41-47
Maturitas

Original Article
Childhood lung function as a determinant of menopause-dependent lung function decline

https://doi.org/10.1016/j.maturitas.2021.08.001Get rights and content

Highlights

  • Lung function declines especially rapidly in postmenopausal women who had poor lung function during childhood.

  • Strategies to reduce respiratory morbidity are required.

  • Strategies to reduce respiratory morbidity need to consider the whole lifespan.

Abstract

Rationale

The naturally occurring age-dependent decline in lung function accelerates after menopause, likely due to the change of the endocrine balance. Although increasing evidence shows suboptimal lung health in early life can increase adult  susceptibility to insults, the potential effect of poor childhood lung function on menopause-dependent lung function decline has not yet been investigated.

Objectives

To study whether menopause-dependent lung function decline, assessed as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), is determined by childhood lung function.

Methods

The Tasmanian Longitudinal Health Study, a cohort born in 1961, underwent spirometry at age seven.  At ages 45 and 50 serum samples, spirometry and questionnaire data were collected (N = 506). We measured follicle stimulating and luteinizing hormones to determine menopausal status using latent profile analysis. The menopause-dependent lung function decline was investigated using linear mixed models, adjusted for anthropometrics, occupational level, smoking, asthma, asthma medication and study year, for the whole study population and stratified by tertiles of childhood lung function.

Measurements and Main Results

The overall menopause-dependent lung function decline was 19.3 mL/y (95%CI 2.2 to 36.3) for FVC and 9.1 mL/y (-2.8 to 21.0) for FEV1. This was most pronounced (pinteraction=0.03) among women within the lowest tertile of childhood lung function [FVC 22.2 mL/y (1.1 to 43.4); FEV1 13.9 mL/y (-1.5 to 29.4)].

Conclusions

Lung function declines especially rapidly in postmenopausal women who had poor low lung function in childhood. This provides novel insights into respiratory health during reproductive aging and emphasizes the need for holistic public health strategies covering the whole lifespan.

Introduction

With menopause begins the non-reproductive phase of a woman's life, including crucial changes of the activity of the hypothalamo-pituitary-gonadal axis [1]. The ovaries cease estrogen production and circulating concentrations of follicle stimulating hormone (FSH) and luteinizing hormone (LH) rise [2]. This entails various adverse health effects, such as osteoporosis and increased risk of developing diabetes or cardiovascular diseases [3], [4], [5], [6], [7]. Interestingly, also the naturally occurring age-dependent lung function decline is accelerated after menopause (menopause-dependent lung function decline) [8]. Lung function is a major predictor of longevity and quality of life, which thus gains even more importance as nowadays most women live far beyond the age of menopause [9]. After menopause the total lung function decline thus displays the sum of age-dependent and menopause-dependent lung function decline. Therefore it is pivotal to understand how to preserve good health and quality of life after menopause, for instance through prevention of excess menopause-dependent lung function decline [1, [10], [11], [12]].

Existing research already shows, that deficient lung growth in childhood is associated with negative pulmonary outcomes, even in the absence of a rapid decline during adult life [13], [14], [15]. Threfore, we hypothesize a priori that poor childhood lung function, which is associated with less than optimal lung function achieved [16], may further exacerbate the menopause-dependent lung function decline. Investigation into this research question may help strengthen the focus on modifiable factors during childhood with subsequent improvements in respiratory health during adult life [1, [10], [11], [12]]. Furthermore, and perhaps even more practically, such evidence will provide an impetus to support interventions on preconceptional, early life housing conditions and smoking cessation to halt worsening respiratory health during reproductive aging. Therefore, we assessed differences in menopause-dependent lung function decline between women with poor, regular and high childhood lung function.

Section snippets

Study design and population

The current analysis includes data from women born in 1961, participating in the Tasmanian Longitudinal Health Study (TAHS), for which the detailed methodology has been reported elsewhere [17]. In brief, the TAHS started in 1968 when 8583 Tasmanian children at age seven, were enrolled by their parents. The parents completed a respiratory health questionnaire for their child, who then underwent clinical examination and spirometry. The participants were followed-up regularly and the current

Results

The included 506 women provided a total of 737 observations across the two follow-ups  conducted at age 45 years and 50 years. Two hundred eight women contributed with one pulmonary function test and 298 women contributed with two pulmonary function tests. The latent profile analysis estimated 426 observations (57.8%) to be from nonmenopausal women and 311 observations (42.2%) to be from postmenopausal women. Fig. 2 shows the corresponding concentrations, as well as the grouping pattern.

Discussion

To our knowledge, this is the first study investigating menopause-dependent lung function decline in relation to childhood lung function. We observed that the menopause-dependent FVC decline was significantly higher in women within the lowest tertile of childhood lung function, which is a novel finding. The menopause-dependent FEV1 decline showed a similar trend but was marginally significant. The menopause-dependent lung function decline being more pronounced for FVC than for FEV1  points

Conclusions

Lung function decline, characterized by the change in FVC, after menopause is greater among women with poor childhood lung function. Similar patterns were observed for FEV1. Our findings highlight the importance of childhood lung function as a determinant of respiratory health during reproductive aging and are relevant for the quality of life of women worldwide. Screening for low lung function in childhood might support policy-makers to develop holistic strategies to protect the subsequent most

Conflict of interest

The authors declare that they have no conflict of interest.

CRediT authorship contribution statement

Kai Triebner: Conceptualization, Data curation, Formal analysis, Writing – original draft. Dinh Bui: Conceptualization, Data curation, Formal analysis, Writing – original draft. Eugene Haydn Walters: Writing – review & editing, Writing – original draft. Michael J Abramson: Funding acquisition, Writing – review & editing, Writing – original draft. Gayan Bowatte: Data curation, Writing – review & editing, Writing – original draft. Brittany Campbell: Data curation, Writing – review & editing,

Funding

KT has received a postdoctoral fellowship from the University of Bergen. The study was supported by the National Health and Medical Research Council (NHMRC) of Australia, research grant 299901; the University of Melbourne; Clifford Craig Foundation; the Victorian, Queensland and Tasmanian Asthma Foundations; Royal Hobart Hospital; Helen MacPherson Smith Trust; GlaxoSmithKline. JLP, CJL, AJL, EHW and SCD are further funded through the NHMRC of Australia. PD is funded by a Ramón y Cajal fellowship

Ethical approval

This study was approved by the Human Ethics Review Committees at The University of Melbourne (Ethics ID: 1647529).

Provenance and peer review

This article was not commissioned and was externally peer reviewed.

Research data (data sharing and collaboration) (all research papers)

This article has an online data supplement. Otherwise, there are no linked research data sets for this paper. Data will be made available on request.

Acknowledgments

We thank all participants, field workers and coordinators of the TAHS for their efforts as well as Ersilia Bifulco and Sandra Suske from the Core Facility for Metabolomics at the University of Bergen for work done in connection with the hormone measurements. Further, we are very grateful for the travel support, granted by EPINOR.

References (41)

  • D.M. Mannino et al.

    Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study

    Thorax

    (2003)
  • ST/ESA/SER.A/261. Department of Economic and Social Affairs Population Division World Population Prospects The 2006...
  • WHO. The Global Health Observatory....
  • V.J. Thannickal et al.

    Blue journal conference. Aging and susceptibility to lung disease

    Am. J. Respir. Crit. Care Med.

    (2015)
  • A. Tai et al.

    The association between childhood asthma and adult chronic obstructive pulmonary disease

    Thorax

    (2014)
  • D.S. Bui et al.

    Childhood lung function predicts adult chronic obstructive pulmonary disease and asthma–chronic obstructive pulmonary disease overlap syndrome

    Am. J. Respir. Crit. Care Med.

    (2017)
  • M.C. Matheson et al.

    Cohort profile: the Tasmanian longitudinal health study (TAHS)

    Int. J. Epidemiol.

    (2017)
  • M.R. Miller et al.

    Standardisation of spirometry

    Eur. Respir. J.

    (2005)
  • K. Triebner et al.

    A sensitive method for estrogen profiling in human serum by liquid chromatography–tandem mass spectrometry., 16th European Congress of Endocrinology

    Endocr. Abstr.

    (2014)
  • D.A. Linzer et al.
    (2011)
  • Cited by (1)

    • Gender differences and sex-related hormonal factors in asthma

      2023, Asthma in the 21st Century: New Research Advances
    1

    shared last authorship

    View full text