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Bronchial hyper-responsiveness in preterm-born subjects: A systematic review and meta-analysis

Sailesh Kotecha1, Hege Clemm2, Thomas Halvorsen2,3

  • 1Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|July 18, 2018
PubMed

Insights

Preterm survivors show higher rates of bronchial hyper-responsiveness (BHR), particularly those with chronic lung disease (CLD). This suggests potential benefits from targeted therapies for these individuals.

Area of Science:

  • Pulmonology and Respiratory Medicine
  • Pediatric Health
  • Clinical Epidemiology

Background:

  • Preterm-born individuals often experience respiratory issues, including diminished lung function.
  • The precise nature and prevalence of bronchial hyper-responsiveness (BHR) in preterm survivors remain incompletely understood.
  • Chronic lung disease (CLD) in infancy is a known complication in preterm survivors, potentially influencing respiratory outcomes.

Purpose of the Study:

  • To systematically review and meta-analyze the prevalence of BHR in preterm-born survivors.
  • To compare BHR rates between preterm-born survivors (with and without CLD) and term-born controls.
  • To identify potential therapeutic targets for BHR in specific subgroups of preterm survivors.

Main Methods:

  • A systematic literature search was conducted across eight databases up to December 2016.
  • Included studies compared BHR in preterm-born and term-born subjects, focusing on studies measuring decreases in forced expiratory volume in 1-second (FEV1) post-provocation.
  • Meta-analysis was performed using Review Manager V5.3 to pool odds ratios (OR) for BHR.

Main Results:

  • The meta-analysis included 28 studies, with 18 contributing to the primary meta-analysis on BHR prevalence.
  • Preterm-born subjects exhibited a significantly higher pooled odds ratio (OR) for BHR (1.88) compared to term-born subjects.
  • BHR rates were notably higher after methacholine challenge (OR 1.89) and exercise testing (OR 2.59), with even greater differences observed in preterm survivors with CLD (OR 4.35 for methacholine, OR 5.13 for exercise).

Conclusions:

  • Preterm-born individuals, especially those with a history of CLD, demonstrate increased rates of bronchial hyper-responsiveness.
  • This heightened BHR occurs in response to both direct (methacholine) and indirect (exercise) stimuli.
  • Findings suggest that specific subgroups of preterm survivors may benefit from anti-inflammatory or bronchodilator therapies to manage BHR.
Abstract

Keywords:
asthmabronchial hyper-responsivenessbronchopulmonary dysplasiachronic lung disease of prematurityexercisemethacholineprematurity

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