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Asthma and Height in Twins: A Cohort and Within-Pair Analyses Study

  • Jennifer L. P. Protudjer (a1) (a2) (a3), Cecilia Lundholm (a1) and Catarina Almqvist (a1) (a2) (a4)


In singletons, asthma may be associated with shorter height and delayed growth during adolescence. Yet, these studies do not account for heritability of asthma, puberty/menarche, and height. We aimed to study the association between asthma and puberty in boys and menarche in girls, and height, in a cohort of twins and subsequently in same-sex twin pairs discordant for asthma. From a Swedish twin cohort, parent- and self-reported data on asthma, puberty/menarche, and height were collected. Pubertal staging was established via the Petersen index. Logistic and linear regression was used to estimate associations between asthma and puberty/menarche and height, respectively. For within-pair analyses in twins discordant for asthma, conditional logistic and linear regression were used. Data on 2,658 (49.1% boys) twins were included. Among boys, asthma prevalence was 8.2% at 8–9 years and 10.2% at 13–14 years. Corresponding numbers for girls were 4.2% and 4.9%, respectively. In the entire cohort, no statistically significant associations were found between current asthma and puberty/menarche. Boys with asthma were shorter than boys without asthma at 8–9 years (on average, 1.86 [0.17–3.56] cm, p = .03) and at 13–14 years (on average, 2.94 [0.98–4.91] cm, p = .003) but not at 19–20 years. No such associations were found for girls. Within same-sex twin pairs discordant for asthma, no statistically significant associations were found for either sex. Twin boys, but not girls, with asthma were shorter than those without asthma. Non-statistically significant estimates from within-pair analyses suggest the association is partly confounded by genetic or familial environmental factors.

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Corresponding author

address for correspondence: Jennifer L. P. Protudjer, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, Stockholm SE-171 77, Sweden. E-mail:


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Akinbami, L. J., Moorman, J. E., & Liu, X. (2011). Asthma prevalence, health care use, and mortality: United States, 2005–2009. National Health Statistics Reports, 12, 114.
Almqvist, C. A., Worm, M., & Leynaert, B. (2008). Impact of gender on asthma in childhood and adolescence: A GA2LEN review. Allergy, 63, 4757.
Asher, M. I., Keil, U., Anderson, H. R., Beasley, R., Crane, J., Martinez, F., . . . Williams, H. C. (1995). International study of asthma and allergies in childhood (ISAAC): Rationale and methods. European Respiratory Journal, 8, 483491.
Asher, M. I., Montefort, S., Björkstén, B., Lai, C. K., Strachan, D. P., Weiland, S. K., . . . ISAAC Phase Three Study Group. (2006). Worldwide time trends in the prevalence of asthma symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases one and three repeat multicountry cross-sectional surveys. Lancet, 368, 733743.
Brettschneider, A.-K., Ellert, U., & Schaffrath Rosario, A. (2012). Comparison of BMI derived from parent-reported height and weight with measured values: Results from the German KiGGS study. International Journal of Environmental Research and Public Health, 9, 632647.
Drosdzol, A., Wilk, K., & Nowosielski, K. (2007). The influence of bronchial asthma on sexual maturation of girls. Journal of Physiology and Pharmacology, 1, 155163.
El-Sayed, Z. A., Hamza, R. T., Sayed, N.-D., & Mahmoud, N. H. (2010). Effect of inhaled corticosteroids on growth and puberty in Egyptian asthmatic children and adolescents. Pakistan Journal of Biological Sciences, 13, 977984.
Fagnani, C., Annesi-Maesano, I., Brescianini, S., D’Ippolito, C., Medda, E., Nistico, L., . . . Stazi, M. A. (2008). Heritability and shared genetic effects of asthma and hay fever: An Italian study of young twins. Twin Reseach and Human Genetics, 11, 121131.
Gasser, T., Molinari, L., & Largo, R. (2013). A comparison of pubertal maturity and growth. Annals of Human Biology, 40, 341347.
Hauspie, R. C., Gyenis, G., Alexander, F., Simon, G., Susanne, C., & Madách, A. (1979). Heights and weights of Hungarian and Belgian asthmatic boys. Human Biology, 51, 507521.
Hauspie, R., Susanne, C., & Alexander, F. (1976). A mixed longitudinal study of the growth in height and weight in asthmatic children. Human Biology, 48, 271283.
Hauspie, R., Susanne, C., & Alexander, F. (1977). Maturational delay and temporal growth retardation in asthmatic boys. Journal of Allergy and Clinical Immunology, 59, 200206.
Hemani, G., Yang, J., Vinkhuyzen, A., Powell, J. E., Willemsen, G., Hottenga, J. J., . . . Visscher, P. M. (2013). Inference of the genetic architecture underlying BMI and height with the use of 20,240 sibling pairs. American Journal of Human Genetics, 93, 865875.
Kaplan, B. A., Brush, G., & Mascie-Taylor, C. G. (1987). The relationship of childhood asthma and wheezy bronchitis with height, weight and body mass index. Human Biology, 59, 921931.
Kelly, H. W., Sternberg, A. L., Lescher, R., Fuhlbrigge, A. L., Williams, P., Zeiger, R. S., . . . CAMP Research Group. (2012). Effect of inhaled corticosteroids in childhood on adult height. New England Journal of Medicine, 367, 904912.
Koenis, M. M., Brouwer, R. M., van Baal, G. C., van Soelen, I. L., Peper, J. S., van Leeuwen, M, . . . Hulshoff Pol, H. E. (2013). Longitudinal study of hormonal and physical development in young twins. Journal of Clinical Endocrinology and Metabolism, 98, E518527.
Legleye, S., Beck, F., Spilka, S., & Chau, N. (2014). Correction of body-mass index using body-shape perception and socioeconomic status in adolescent self-report surveys. PLoS One, 9, e976768.
Lichtenstein, P., & Svartengren, M. (1997). Genes, environment, and sex: Factors of importance in atopic diseases in 7–9-year-old Swedish twins. Allergy, 52, 10791086.
Lichtenstein, P., Tuvblad, C., Larsson, H., & Carlström, E. (2007). The Swedish twin study of CHild and adolescent development: The TCHAD-Study. Twin Research and Human Genetics, 10, 6773.
Martin, A. J., Landau, L. I., & Phelan, P. D. (1981). The effect of growth on childhood asthma. Acta Paediatrica Scand, 70, 683688.
Mayo, O. (2009). Early research on human genetics using the twin method: Who really invented the method? Twin Research and Human Genetics, 12, 237245.
Mogensen, N., Larsson, H., Lundholm, C., & Almqvist, C. (2011). Association between childhood asthma and ADHA symptoms in adolescence — A prospective population-based twin study. Allergy, 66, 12241230.
Moodie, E. M. M., & Stephens, D. A. (2010). Use of directed acyclic graphs to detect limitations of traditional regression in longitudinal studies. International Journal of Public Health, 55, 701703.
Moudiou, T., Theophilatou, D., Prifits, K., & Papadimitriou, A. (2003). Growth of asthmatic children before long-term treatment with inhaled corticosteroids. Journal of Asthma, 40, 667671.
Neville, R. G., McCowan, C., Thomas, G., & Crombie, I. K. (1996). Asthma and growth —- cause for concern? Asthma and growth in Tayside children. Annals of Human Biology, 23, 323331.
Nicolai, T., Pereszlenyiova-Bliznakova, L., Illi, S., Reinhardt, D., & von Mutius, E. (2003). Longitudinal follow-up of the changing gender ratio in asthma from childhood to adulthood: Role of delayed manifestation in girls. Pediatric Allergy and Immunology, 14, 280283.
Norjavaara, E., Gerhardsson de Verdier, M., & Lindmark, B. (2001). Adult height in women with childhood asthma — A population-based study. Pharmacoepidemiology and Drug Safety, 10, 121125.
Örtqvist, A. K., Lundholm, C., Carlström, E., Lichtenstein, P., Cnattingius, S., & Almqvist, C. (2009). Familial factors do not confound the association between birth weight and childhood asthma. Pediatrics, 124, e737743.
Petersen, A. C., Crockett, L., Richards, M., & Boxer, A. (1988). A self-report measure of pubertal status: Reliability, validity, and initial norms. Journal of Youth and Adolescence, 17, 117133.
Protudjer, J. L. P., Lundholm, C., Bergstrom, A., Kull, I., & Almqvist, C. (2014). Puberty and asthma in a cohort of Swedish children. Annals of Allergy, Asthma & Immunology, 112, 7879.
Schofield, M. L. (2014). Asthma pharmacotherapy. Otolaryngolic Clinics of North America, 47, 5564.
Skrzypuklec, V., Doniec, Z., Drosdzol, A., Nowosielski, K., & Pawlinska-Chmara, R. (2007). The influence of bronchial asthma on premenstrual syndrome prevalence amongst girls. Journal of Physiology and Pharmacology, 58, 639646.
Strunk, R. C., Sternberg, A. L., Szefler, S. J., Zeiger, R. S., Bender, B., Tonascia, J., . . . CAMP Research Group. (2009). Long-term budesonide or nedocromil treatment, once discontinued, does not alter the course of mild to moderate asthma in children. Journal of Pediatrics, 154, 682687.
Tai, A., Tran, H., Roberts, M., Clark, N., Gibson, A M., Vidmar, S., . . . Robertson, C. F. (2014). Outcomes of childhood asthma to the age of 50 years. Journal of Allergy and Clinical Immunology, 133, 15721578.
The Childhood Asthma Management Program Research Group. (2000). Long term effects of budesonide or nedocromil in children with asthma. New England Journal of Medicine, 343, 10541063.
Thomsen, S. F., Kyvik, K. O., & Backer, V. (2008). Etiological relationships in atopy: A review of twin studies. Twin Research and Human Genetics, 11, 112120.
Thomsen, S. F., van der Sluis, S., Kyvik, K. O., Skytthe, A., & Backer, A. (2010). Estimates of asthma heritability in a large twin sample. Clinical and Experimental Allergy, 40, 10541064.
Umlawska, W., Gaszczyk, G., & Sands, D. (2013). Physical development in children and adolescents with bronchial asthma. Respiratry Physiology and Neurobiology, 187, 108113.
van den Berg, S. M., Setiawan, A., Bartels, M., Polderman, T. J., van der Vaart, A. W., & Boomsma, D. I. (2006). Individual differences in puberty onset in girls: Bayesian estimation of heritabilities and genetic correlations. Behavior Genetics, 36, 261270.
Wang, Y., Dinse, G. E., & Rogan, W. J. (2012). Birth weight, early weight gain and pubertal maturation: A longitudinal study. Pediatric Obesity, 7, 101109.
WHO Expert Committee on Physical Status. (1995). Physical status: The use and interpretation of anthropometry. Retrieved from
Yoshitake, N., Okusa, M., Sasaki, S., Kunitsugu, I., & Hobara, T. (2012). Validity of self-reported body mass index of Japanese children and adolescents. Pediatrics International, 54, 397401.



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