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Preterm birth and asthma and COPD in adulthood: a nationwide register study from two Nordic countries
Anna Pulakka1,2, Kari Risnes3,4, Johanna Metsälä5
1Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland anna.pulakka@thl.fi.
Insights
Preterm birth significantly increases the risk of adult obstructive airway diseases like asthma and COPD. Very preterm infants face the highest risk, emphasizing the need for ongoing respiratory monitoring.
Area of Science:
- Pulmonary Medicine
- Neonatology
- Epidemiology
Background:
- Preterm birth impacts lung development, with limited long-term follow-up into adulthood.
- Investigating the full spectrum of gestational ages and adult obstructive airway disease is crucial.
Purpose of the Study:
- To examine the association between gestational age at birth and adult specialist care for obstructive airway diseases (asthma and COPD).
- To assess risks up to age 50 years for individuals born preterm.
Main Methods:
- Utilized nationwide registry data from Finland and Norway, encompassing over 2.3 million births.
- Employed logistic regression to calculate odds ratios for asthma and COPD diagnoses in adulthood.
- Analyzed data for individuals aged 18-50 years, with specific focus on COPD in the 30-50 age group.
Main Results:
- Individuals born very preterm (<28 or 28-31 weeks) had a 2-3 fold increased odds of adult obstructive airway disease.
- A dose-response relationship was observed, with higher odds for earlier preterm births.
- Infant bronchopulmonary dysplasia further elevated the risk of adult COPD for the most preterm infants.
Conclusions:
- Preterm birth is a significant risk factor for developing asthma and COPD in adulthood.
- Heightened vigilance for COPD is recommended in adults born very preterm presenting with respiratory symptoms.
Background:
Preterm birth affects lungs in several ways but few studies have follow-up until adulthood. We investigated the association of the entire spectrum of gestational ages with specialist care episodes for obstructive airway disease (asthma and chronic obstructive pulmonary disease (COPD)) at age 18-50 years.
Methods:
We used nationwide registry data on 706 717 people born 1987-1998 in Finland (4.8% preterm) and 1 669 528 born 1967-1999 in Norway (5.0% preterm). Care episodes of asthma and COPD were obtained from specialised healthcare registers, available in Finland for 2005-2016 and in Norway for 2008-2017. We used logistic regression to estimate odds ratios (ORs) for having a care episode with either disease outcome.
Results:
Odds of any obstructive airway disease in adulthood for those born at <28 or 28-31 completed weeks were 2-3-fold of those born full term (39-41 completed weeks), persisting after adjustments. For individuals born at 32-33, 34-36 or 37-38 weeks, the odds were 1.1- to 1.5-fold. Associations were similar in the Finnish and the Norwegian data and among people aged 18-29 and 30-50 years. For COPD at age 30-50 years, the OR was 7.44 (95% CI 3.49-15.85) for those born at <28 weeks, 3.18 (95% CI 2.23-4.54) for those born at 28-31 weeks and 2.32 (95% CI 1.72-3.12) for those born at 32-33 weeks. Bronchopulmonary dysplasia in infancy increased the odds further for those born at <28 and 28-31 weeks.
Conclusion:
Preterm birth is a risk factor for asthma and COPD in adulthood. The high odds of COPD call for diagnostic vigilance when adults born very preterm present with respiratory symptoms.
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