Early inhaled budesonide in extremely preterm infants decreases long-term respiratory morbidity

There is no strict correlation between early bronchopulmonary dysplasia and long-term respiratory disease. Early inhaled corticosteroids seem to reduce the incidence of bronchopulmonary dysplasia, but the long-term outcome remains unknown.

The aim of this study was to evaluate the effect of early inhaled corticosteroids on chronic respiratory morbidity.

Fifty-nine survivors from the Prague cohort included in Neonatal European Study of Inhaled Steroids underwent further follow-up comprising of respiratory morbidity monitoring during the first 2 years of life followed by objective lung function testing performed at the age of 5.9 years (range 5-7 years). Both outcomes were pursued and finalized before the unblinding of budesonide subgroups.

Fifty randomized (budesonide vs placebo group, 56% vs 44%) survivors were included in the study. Spirometry was successfully performed in 48 children. No statistically significant differences were found in the lung function test (forced expiratory flow [FEF] - FEF₇₅ , FEF_50, FEF₂₅ , and FEF_25-75; FEV₁ , forced vital capacity [FVC], FEV₁ /FVC) although mild trend to the improvement of expiratory flow pattern was observed in the budesonide group (median z-score of FEV₁ /FVC -0.376 vs -0.983, P = .13; median z-score of FEF_25-75 -1.004 vs -1.458, P = .13; median z-score of FEF₇₅ -0.527 vs -0.996, P = .17). Children assigned to budesonide had a significantly lower rate of symptoms of chronic lung disease (34.6% vs 68.2%; P = .04) than children assigned to placebo.

Our study suggests that early inhaled budesonide was associated with the trend to the improvement of functional lung parameters and with a lower rate of symptoms of chronic lung disease within the first 2 years of life.