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RespiratoryMar 7, 2023

Tackle respiratory infections in childhood in order to reduce premature mortality at later stage

Practitioners and policy makers must focus more attention on children’s respiratory health, according to the lead author of a study that is published today (8 March) in The Lancet.

James Allinson, who is based at Imperial College London, said the results suggested that too much attention is currently being placed on ‘lifestyle factors’ – and that certain groups are stigmatised as a result. The study found that contracting a respiratory infection in early childhood was associated with a higher risk of dying from respiratory disease as an adult.

‘Current preventative measures for adult respiratory disease mainly focus on adult lifestyle risk factors such as smoking,’ Professor Allinson said. ‘Linking one in five of adult respiratory deaths to common infections many decades earlier in childhood shows the need to target risk well before adulthood.’

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The authors hope the findings will guide international health organisations' strategies

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'Tackle childhood poverty'

In order to avoid perpetuating existing patterns of adult health inequalities, there was an urgent need to ‘optimise’ childhood health – not least by tackling childhood poverty, Professor Allinson noted.

‘Evidence suggesting the early life origins of adult chronic diseases also helps challenge the stigma that all deaths from diseases such as COPD [chronic obstructive pulmonary disease] are related to lifestyle factors.’

The study conducted by Professor Allinson and his colleagues focused on 3,589 people who were aged over 73. They found that children who had a lower respiratory tract infection (LRTI) – such as bronchitis or pneumonia – by the age of two were almost twice as likely to die prematurely in adulthood from respiratory diseases, independent of socioeconomic factors and smoking status. 

This could potentially account for one in five premature deaths from respiratory disease in England and Wales from 1972 to 2019 (179,188 out of 878,951 deaths).

Having a LRTI by age of two was important factor

The research team used data from a nationwide British cohort (National Survey of Health and Development), which recruited individuals at birth in 1946, looking at health and death records up to the year 2019. Of the 3,589 study participants, 25 per cent (913/3,589) had a LRTI before the age of two. By the end of 2019, 19 per cent (674/3,589) of participants had died before the age of 73 years old. Among these 674 premature adult deaths, 8 per cent (52/674) participants died from respiratory disease, mostly COPD. 

Analysis adjusting for socioeconomic background during childhood and smoking status, suggests children who had a LRTI by the age of two were 93 per cent more likely to die prematurely as adults from respiratory disease, than children who had not had a LRTI by age two. This equates to a 2.1 per cent rate of premature adult death from respiratory disease among those who had a LRTI in early childhood, compared to 1.1 per cent among those who did not report a LRTI before the age of two. 

The results of our study suggest that efforts to reduce childhood respiratory infections could have an impact on tackling premature mortality from respiratory disease later in life [Rebecca Hardy]

This risk accounts for one in five (20.4 per cent) of premature respiratory-caused adult deaths, corresponding to 179,188 excess deaths from respiratory diseases across England and Wales from 1972 to 2019. In comparison adult respiratory deaths attributable to smoking account for three in five of deaths (57.7 per cent) from respiratory disease in England and Wales over the same period (507,223 out of 878,951 deaths).

Having a lower respiratory infection before the age of two was only associated with an increased risk of premature death from respiratory diseases, and not other illnesses, such as heart disease or cancers. 

Limitations of study

The authors acknowledge that the study had some limitations. Although socioeconomic background and smoking were adjusted for in the analysis, there may have been other factors that were unreported, such as parental smoking and being born prematurely. During this life spanning study, societal change may also have driven changes in lung function of subsequent cohorts, altering outcomes. The team was unable to investigate which bacteria or viruses caused the LRTI in the children.


Chronic respiratory diseases pose a major public health problem, with an estimated 3.9 million deaths in 2017, accounting for 7 per cent of all deaths worldwide. COPD caused most of these deaths.

‘The results of our study suggest that efforts to reduce childhood respiratory infections could have an impact on tackling premature mortality from respiratory disease later in life,’ said Rebecca Hardy, a professor of epidemiology and medical statistics at Loughborough University who is also based at University College London.

Professor Hardy added: ‘We hope that this study will help guide the strategies of international health organisations in tackling this issue.’

To read the full version of the article – titled Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study – visit: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00131-9/fulltext

Author: Ian A McMillan
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