Effect of Bronchodilators on Forced Expiratory Volume in 1 s in Preterm-Born Participants Aged 5 and Over: A Systematic Review

Abstract

Background and Objectives: Preterm-born participants are at risk of long-term deficits in percentage predicted forced expiratory volume in 1 s (%FEV₁). Since it is unclear if these deficits respond to bronchodilators, we systematically reviewed the evidence for reversibility of deficits in %FEV₁ by bronchodilators in preterm-born participants. Design: Studies reporting a change in %FEV₁ in response to bronchodilator treatment in preterm-born participants at ≥5 years of age, with or without a term-born control group, were identified. The quality of studies was assessed by adapted tools. Due to considerable heterogeneity between studies, formal meta-analysis was not possible. Results: From 8,839 titles, 22 studies were identified after an updated search in May 2013. Twenty-one studies assessed the response to a single inhaled dose of a bronchodilator, and 1 study assessed longer-term effects. Most studies observed decreased %FEV₁ in preterm-born participants compared with controls. Most studies observed improved %FEV₁ after a single dose of bronchodilator, with the largest improvements noted in those with bronchopulmonary dysplasia, who had greater deficits of %FEV₁ when compared with preterm and term controls. One long-term study investigated a 2-week terbutaline administration, but the initial FEV₁ after a single dose did not show a change in %FEV₁ of ≥15%, but 5/29 (17%) children had an increased %FEV₁ of ≥10%. Conclusions: In this systematic review, disparate studies were identified. Although single doses of bronchodilators appear to improve the FEV₁ in the short term, further studies are required to assess their longer-term benefits not only on airway obstruction, but also their effect on respiratory symptoms.

Response to bronchodilators in very preterm infants with evolving bronchopulmonary dysplasia

“…This criteria is based on the 2002 NHLBI expert panel recommendations for the diagnosis and management of asthma. 15 We then assessed responders for associated changes in compliance (Crs, mL/cmH2O/kg) and tidal volume (Vt, ml/kg).…”

Adults born preterm: a review of general health and system-specific outcomes

“…As this report did not provide search history results, we have not included this review in the table. A systematic review of 21 publications summarised that preterm‐born adults had significantly decreased per cent forced expiratory volume by 1 second, which improved following a single dose bronchodilator, and the response was larger in those who had suffered from bronchopulmonary dysplasia (BPD) during the neonatal period . Other reports corroborate the increased airway resistance , decreased exercise tolerance and reduced carbon monoxide diffusion capacity among adults born preterm.…”

Lung consequences in adults born prematurely

“…Additional evidence for optimal treatment is required 78. They should be introduced on the basis of an individual therapeutic trial and should be discontinued unless there is documented objective improvement.…”