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Updated: Sep 21, 2025
Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
Published on: August 24, 2019
Impaired exercise outcomes with significant bronchodilator responsiveness in children with prematurity-associated
Michael Cousins1, Kylie Hart1, E Mark Williams2
1Department of Child Health, Cardiff University School of Medicine, Cardiff, UK.
Insights
Preterm-born children with obstructive lung disease show the most significant exercise capacity issues and benefit most from bronchodilators. These findings can help guide treatment for children with prematurity-associated obstructive lung disease (POLD).
Area of Science:
- Pediatric Pulmonology
- Neonatal Health Outcomes
- Exercise Physiology
Background:
- Preterm birth interrupts normal lung development, increasing risks for short- and long-term lung disease.
- Children born preterm, especially those with chronic lung disease of prematurity (CLD), often exhibit spirometry and exercise capacity impairments.
- Specific lung function phenotypes may differentially impact exercise capacity in this population.
Purpose of the Study:
- To investigate exercise capacity differences in preterm-born children with specific lung function phenotypes: prematurity-associated obstructive lung disease (POLD) and prematurity-associated preserved ratio of impaired spirometry (pPRISm).
- To compare exercise capacity in these groups against preterm- and term-born controls with normal lung function.
- To assess the impact of bronchodilator response on exercise capacity in these distinct groups.
Main Methods:
- Utilized data from the Respiratory Health Outcomes in Neonates (RHiNO) study, including lung function and cardiorespiratory exercise testing.
- Included children aged 7-12 years, categorized into POLD (n=18), pPRISm (n=12), preterm-controls (PTc, n=106), and term-controls (T_c, n=66).
- Administered postexercise bronchodilator testing to evaluate airway reversibility.
Main Results:
- Children with POLD exhibited reduced relative workload, peak oxygen uptake, carbon dioxide production, and minute ventilation compared to term-controls.
- POLD children utilized a greater proportion of their breathing reserve than both control groups.
- POLD children showed the most significant improvement in FEV1 (19.4%) after bronchodilator administration compared to pPRISm, PTc, and Tc groups (p < .001).
Conclusions:
- Preterm-born children with obstructive airway disease (POLD) experience the greatest exercise capacity impairments.
- These children also demonstrate a significantly greater positive response to postexercise bronchodilators.
- Classification into POLD can inform and guide therapeutic strategies for affected children.
Introduction:
Preterm-born children have their normal in-utero lung development interrupted, thus are at risk of short- and long-term lung disease. Spirometry and exercise capacity impairments have been regularly reported in preterm-born children especially those who developed chronic lung disease of prematurity (CLD) in infancy. However, specific phenotypes may be differentially associated with exercise capacity. We investigated exercise capacity associated with prematurity-associated obstructive (POLD) or prematurity-associated preserved ratio of impaired spirometry (pPRISm) when compared to preterm- and term-controls with normal lung function.
Materials And Methods:
Preterm- and term-born children identified through home screening underwent in-depth lung function and cardiorespiratory exercise testing, including administration of postexercise bronchodilator, as part of the Respiratory Health Outcomes in Neonates (RHiNO) study.
Results:
From 241 invited children, aged 7-12 years, 202 underwent exercise testing including 18 children with POLD (percent predicted (%)FEV1 and FEV1 /FVC < LLN); 12 pPRISm (%FEV1 < LLN and FEV1 /FVC ≥ LLN), 106 preterm-controls (PTc , %FEV1 ≥ LLN) and 66 term-controls (Tc , %FEV1 > 90%). POLD children had reduced relative workload, peak O2 uptake, CO2 production, and minute ventilation compared to Tc , and used a greater proportion of their breathing reserve compared to both control groups. pPRISm and PTc children also had lower O2 uptake compared to Tc . POLD children had the greatest response to postexercise bronchodilator, improving their %FEV1 by 19.4% (vs 6.3%, 6% 6.3% in pPRISm PTc, Tc , respectively; p < .001).
Conclusion:
Preterm-born children with obstructive airway disease had the greatest impairment in exercise capacity, and significantly greater response to postexercise bronchodilators. These classifications can be used to guide treatment in children with POLD.
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