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Structural and Functional Lung Impairment in Adult Survivors of Bronchopulmonary Dysplasia
Steven Caskey1, Aisling Gough1, Stephen Rowan1
11 Centre for Infection and Immunity and.
Insights
Adults who survived bronchopulmonary dysplasia (BPD) as infants show lasting lung impairment and respiratory symptoms. This highlights the critical need for long-term monitoring of BPD survivors for optimal respiratory health.
Area of Science:
- Pulmonary Medicine
- Neonatology
- Adult Respiratory Health
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants.
- Increasing survival rates of preterm infants with severe BPD necessitate understanding long-term health consequences.
- Adult lung health in BPD survivors remains understudied.
Purpose of the Study:
- To evaluate structural and functional lung parameters in young adult survivors of BPD.
- To compare lung health outcomes between BPD survivors, preterm non-BPD controls, and term-born controls.
- To identify clinical consequences of BPD on adult lung health.
Main Methods:
- Young adult BPD survivors and control groups underwent comprehensive pulmonary function tests.
- High-resolution chest computed tomography (HRCT) and cardiopulmonary exercise testing were performed.
- Statistical analyses compared lung parameters, respiratory symptoms, and exercise capacity across groups.
Main Results:
- BPD survivors reported more nocturnal cough, wheezing, and breathlessness compared to term controls.
- Significant airflow obstruction and impaired gas transfer were observed in BPD survivors and preterm non-BPD controls.
- BPD survivors exhibited more severe radiographic lung abnormalities and impaired exercise capacity.
Conclusions:
- Adult preterm birth survivors, particularly those with a history of BPD, experience persistent respiratory symptoms.
- Clinically significant pulmonary impairment, including airflow obstruction and reduced gas transfer, is common in BPD survivors.
- Long-term follow-up is crucial for managing the respiratory health of adult BPD survivors.
Rationale:
As more preterm infants recover from severe bronchopulmonary dysplasia (BPD), it is critical to understand the clinical consequences of this condition on the lung health of adult survivors.
Objectives:
To assess structural and functional lung parameters in young adult BPD survivors and preterm and term control subjects.
Methods:
Young adult survivors of BPD (mean age, 24 yr) underwent spirometry, lung volume assessment, transfer factor, lung clearance index, and fractional exhaled nitric oxide measurements, together with high-resolution chest computed tomography and cardiopulmonary exercise testing.
Measurements And Main Results:
Twenty-five adult BPD survivors (mean ± SD gestational age, 26.8 ± 2.3 wk; birth weight, 866 ± 255 g), 24 adult prematurely born non-BPD control subjects (gestational age, 30.6 ± 1.9 wk; birth weight, 1,234 ± 207 g), and 25 adult term-birth control subjects (gestational age, 38.5 ± 0.9 wk; birth weight, 3,569 ± 2,979 g) were studied. Subjects with BPD were more likely to be wakened by cough (odds ratio, 9.7; 95% confidence interval, 1.8-52.6; P < 0.01) or wheeze and breathlessness (odds ratio, 12.2; 95% confidence interval; 1.3-112; P < 0.05) than term control subjects after adjusting for sex and current smoking. Preterm subjects had greater airway obstruction than term subjects. Subjects with BPD had significantly lower values for FEV1 and forced expiratory flow, midexpiratory phase (percent predicted and z-scores), than term control subjects (both P < 0.001). Although non-BPD subjects also had lower spirometric values than term control subjects, none of the differences reached statistical significance. More subjects with BPD (25%) had fixed airflow obstruction than non-BPD (12.5%) and term (0%) subjects (P = 0.004). Both BPD and non-BPD subjects had significantly greater impairment in gas transfer (Kco percent predicted) than term subjects (both P < 0.05). Eighteen (37%) preterm participants were classified as small for gestational age (birth weight below the 10th percentile for gestational age). These subjects had significantly greater impairment in FEV1 (percent predicted values and z-scores) than those born appropriate for gestational age. BPD survivors had significantly more severe radiographic structural lung impairment than non-BPD subjects. Both preterm groups had impaired exercise capacity compared with term control subjects. There was a trend for greater limitation and leg discomfort in BPD survivors.
Conclusions:
Adult preterm birth survivors, especially those who developed BPD, continue to experience respiratory symptoms and exhibit clinically important levels of pulmonary impairment.
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