Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: A meta-analysis of 150 000 European children

Evelien R van Meel, Sara M Mensink-Bout, Herman T den Dekker, Tarunveer S Ahluwalia, Isabella Annesi-Maesano, Syed Hasan Arshad, Nour Baïz, Henrique Barros, Andrea von Berg, Hans Bisgaard, Klaus Bønnelykke, Christian J Carlsson, Maribel Casas, Leda Chatzi, Cecile Chevrier, Geertje Dalmeijer, Carol Dezateux, Karel Duchen, Merete Eggesbø, Cornelis van der EntMaria Fantini, Claudia Flexeder, Urs Frey, Fransesco Forastiere, Ulrike Gehring, Davide Gori, Raquel Granell, Lucy J Griffiths, Hazel Inskip, Joanna Jerzynska, Anne M Karvonen, Thomas Keil, Cecily Kelleher, Manolis Kogevinas, Gudrun Koppen, Claudia E Kuehni, Nathalie Lambrechts, Susanne Lau, Irina Lehmann, Johnny Ludvigsson, Maria Christine Magnus, Erik Mélen, John Mehegan, Monique Mommers, Anne-Marie Nybo Andersen, Wenche Nystad, Eva S L Pedersen, Juha Pekkanen, Ville Peltola, Katharine C Pike, Angela Pinot de Moira, Costanza Pizzi, Kinga Polanska, Maja Popovic, Daniela Porta, Graham Roberts, Ana Cristina Santos, Erica S Schultz, Marie Standl, Jordi Sunyer, Carel Thijs, Laura Toivonen, Eleonora Uphoff, Jakob Usemann, Marina Vafeidi, John Wright, Johan C de Jongste, Vincent W V Jaddoe, Liesbeth Duijts*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Early-life respiratory tract infections might affect chronic obstructive respiratory diseases, but conclusive studies from general populations are lacking. Our objective was to examine if children with early-life respiratory tract infections had increased risks of lower lung function and asthma at school age.

METHODS: We used individual participant data of 150 090 children primarily from the EU Child Cohort Network to examine the associations of upper and lower respiratory tract infections from age 6 months to 5 years with forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow at 75% of FVC (FEF75%) and asthma at a median (range) age of 7 (4-15) years.

RESULTS: Children with early-life lower, not upper, respiratory tract infections had a lower school-age FEV1, FEV1/FVC and FEF75% (z-score range: -0.09 (95% CI -0.14- -0.04) to -0.30 (95% CI -0.36- -0.24)). Children with early-life lower respiratory tract infections had a higher increased risk of school-age asthma than those with upper respiratory tract infections (OR range: 2.10 (95% CI 1.98-2.22) to 6.30 (95% CI 5.64-7.04) and 1.25 (95% CI 1.18-1.32) to 1.55 (95% CI 1.47-1.65), respectively). Adjustment for preceding respiratory tract infections slightly decreased the strength of the effects. Observed associations were similar for those with and without early-life wheezing as a proxy for early-life asthma.

CONCLUSIONS: Our findings suggest that early-life respiratory tract infections affect development of chronic obstructive respiratory diseases in later life, with the strongest effects for lower respiratory tract infections.

Original languageEnglish
Article number2102395
Number of pages13
JournalEuropean Respiratory Journal
Issue number4
Publication statusPublished - 1 Oct 2022


  • Asthma
  • Child, Preschool
  • Forced Expiratory Volume
  • Humans
  • Infant
  • Lung
  • Prospective Studies
  • Respiratory Tract Infections
  • Vital Capacity


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