Preterm birth and inhaled corticosteroid use in 6- to 19-year-olds: a Swedish national cohort study
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Hartmut Vogt1, Karolina Lindström, Lennart Bråbäck
1Division of Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. hartmut.vogt@liu.se
Insights
Preterm birth increases the risk of asthma medication use in children and adolescents. The risk is higher with greater prematurity, persisting from early term to extremely preterm births.
Area of Science:
- Pediatric respiratory health
- Public health research
- Epidemiology
Background:
- Preterm birth is linked to long-term respiratory issues, including asthma.
- Existing research primarily focuses on early childhood asthma in extremely preterm infants.
- This study investigates asthma risk across a broader age range and varying degrees of prematurity.
Purpose of the Study:
- To examine the association between gestational age at birth and the risk of asthma in schoolchildren.
- To assess the dose-response relationship between immaturity and asthma risk.
- To evaluate asthma risk across different levels of prematurity.
Main Methods:
- Analysis of a Swedish national cohort of 1,100,826 children aged 6–19 years.
- Asthma identified by at least one prescription for inhaled corticosteroids (ICS) in 2006.
- Logistic regression adjusted for socioeconomic and perinatal factors.
Main Results:
- An inverse dose-response relationship was observed between gestational age and ICS use.
- Children born earlier had a significantly higher odds ratio for ICS use.
- Compared to full-term births (39–41 weeks), odds ratios for ICS use were 1.10 (37–38 weeks) and 2.28 (23–28 weeks).
Conclusions:
- Preterm birth, by degree of immaturity, elevates the risk of asthma in school-aged children and adolescents.
- The risk extends from early term to extremely preterm births.
- This highlights the long-term respiratory implications of preterm birth.
Objective:
Preterm birth is associated with respiratory morbidity later in life, including asthma. Previous studies have mainly focused on asthma in early childhood in children born extremely preterm. In this study, we examined the risk of asthma in a national cohort of schoolchildren grouped according to degree of immaturity expressed as completed gestational weeks at birth.
Methods:
This was a register study in a Swedish national cohort of 1 100 826 children 6 to 19 years old. Retrieval of at least 1 prescription of inhaled corticosteroids (ICS) during 2006 was used as the main indicator for asthma. Logistic regression was used to test hypotheses, with adjustment for multiple socioeconomic and perinatal indicators.
Results:
Degree of immaturity, expressed as completed gestational weeks at birth, had an inverse dose-response relationship with ICS use. Compared with children born between 39 and 41 weeks' gestation, the odds ratio for ICS use increased with the degree of prematurity, from 1.10 (95% confidence interval: 1.08-1.13) for children born in weeks 37 to 38, to 2.28 (95% confidence interval: 1.96-2.64) for children born in weeks 23 to 28, after adjustment for confounders. The increase in ICS use with decreasing gestational age at delivery was similar in boys and girls, and declined with older age.
Conclusion:
Preterm birth increased the risk of ICS use in these 6- to 19-year-olds by degree of immaturity, from extremely preterm to early term birth.
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