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Characterising airway obstructive, dysanaptic and PRISm phenotypes of prematurity-associated lung disease
Michael Cousins1, Kylie Hart1, Sarah J Kotecha1
1Department of Child Health, Cardiff University School of Medicine, Cardiff, UK.
Insights
Preterm-born children exhibit distinct spirometry phenotypes, including airway obstruction and dysanapsis, linked to early life factors. Identifying these lung function patterns can guide targeted therapies for improved outcomes.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Neonatal Health
Background:
- Obstructive airway disease is linked to prematurity, but other spirometry phenotypes are less understood.
- Preterm birth can impact long-term lung function, necessitating detailed characterization of respiratory health in survivors.
Purpose of the Study:
- To characterize abnormal spirometry phenotypes in preterm-born children.
- To associate these phenotypes with early life factors, bronchodilator responsiveness, and fractional exhaled nitric oxide (FE NO ).
Main Methods:
- 768 children (7-12 years) underwent spirometry and FE NO measurements before and after salbutamol.
- Multinomial regression analysis was used to compare groups and identify associations.
Main Results:
- 22.6% of preterm-born children showed abnormal spirometry phenotypes, more prevalent than in term-born children.
- Preterm-associated obstructive lung disease (POLD) was linked to bronchopulmonary dysplasia (BPD) and intrauterine growth restriction.
- Prematurity-associated dysanapsis (pDysanapsis) and prematurity-associated preserved ratio of impaired spirometry (pPRISm) were identified, with distinct associations with bronchodilator response and FE NO .
Conclusions:
- Beyond airway obstruction, airway dysanapsis and pPRISm phenotypes are described in preterm survivors.
- These phenotypes have implications for long-term respiratory health.
- Identifying specific spirometry phenotypes can facilitate the development of targeted therapies to improve outcomes in preterm survivors.
Introduction:
Although obstructive airway disease has been shown to be associated with prematurity, other spirometry phenotypes are less well described.
Objectives:
We characterised abnormal spirometry phenotypes in preterm-born children, including prematurity-associated obstructive lung disease (POLD, forced expiratory volume in 1 s (FEV1)
Methods:
768 children, aged 7-12 years, underwent FENO measurements and spirometry before and after salbutamol. Groups were compared using parametric tests; multinomial regression was used.
Results:
22.6% of 544 preterm-born (mean gestation: 31 weeks) and 9.2% of 195 term-born children, with satisfactory data available, were classified into one of four abnormal spirometry groups. Each phenotype was generally more prevalent in preterm-born children than in the term-born children. For the preterm group, POLD-reversible (4.4%) was associated with increased FENO, bronchopulmonary dysplasia (BPD) and intrauterine growth restriction. POLD-fixed group (3.3%) did not have increased FENO but was associated with BPD. 41% of the pDysanapsis group (5.9%) had bronchodilator response, 31% had increased FENO and was associated with postnatal weight gain. In the pPRISm group (9%), 13% responded to bronchodilators, FENO was not increased and was non-significantly associated with body mass index (p=0.064).
Conclusions:
Further to airway obstruction, we describe airway dysanapsis and pPRISm spirometry phenotypes in survivors of prematurity, both of which have poor outlook in other disease groups. By identifying specific phenotypes, targeted therapy can be developed to improve long-term outcomes.
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