Expiratory Flow – Vital Capacity: Airway – Lung Dysanapsis in 7 Year Olds Born Very Preterm?

Ioan, Iulia; Gemble, Aurore; Hamon, Isabelle; Metche, Stéphanie; Bonabel, Claude; Nguyen-Thi, Phi-Linh; Hascoët, Jean‐Michel; Demoulin‐Alexikova, Silvia; Marchal, François

doi:10.3389/fphys.2018.00650

Cited by 7 publications

(9 citation statements)

References 40 publications

(48 reference statements)

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“…While airway size and lung volume/size grow in parallel, this growth may not always be proportional and may result in smaller airways in relation to lung volume, a phenomenon referred to as dysanapsis [ 34 ]. Recent studies using proxy measures of dysanapsis derived from spirometry suggest that dysanapsis may be a key contributor to airflow impairment in children and adults born very preterm [ 35 , 36 ] and that smallest airways in relation to lung volume are seen in very preterm adults with a history of BPD [ 35 ]. Spirometry-derived indices may, however, underestimate the extent of impairment in lung function.…”

Section: Discussionmentioning

confidence: 99%

Lung function in adults born preterm

et al. 2018

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Very preterm birth, before the gestational age (GA) of 32 weeks, increases the risk of obstructed airflow in adulthood. We examined whether all preterm births (GA<37 weeks) are associated with poorer adult lung function and whether any associations are explained by maternal, early life/neonatal, or current life factors. Participants of the ESTER Preterm Birth Study, born between 1985 and 1989 (during the pre-surfactant era), at the age of 23 years participated in a clinical study in which they performed spirometry and provided detailed medical history. Of the participants, 139 were born early preterm (GA<34 weeks), 239 late preterm (GA: 34-<37 weeks), and 341 full-term (GA≥37 weeks). Preterm birth was associated with poorer lung function. Mean differences between individuals born early preterm versus full-term were -0.23 standard deviation (SD) (95% confidence interval (CI): -0.40, -0.05)) for forced vital capacity z-score (zFVC), -0.44 SD (95% CI -0.64, -0.25) for forced expiratory volume z-score (zFEV1), and -0.29 SD (95% CI -0.47, -0.10) for zFEV1/FVC. For late preterm, mean differences with full-term controls were -0.02 SD (95% CI -0.17, 0.13), -0.12 SD (95% CI -0.29, 0.04) and -0.13 SD (95% CI -0.29, 0.02) for zFVC, zFEV1, and zFEV1/FVC, respectively. Examination of finer GA subgroups suggested an inverse non-linear association between lung function and GA, with the greatest impact on zFEV1 for those born extremely preterm. The subgroup means were GA<28 weeks: -0.98 SD; 28-<32 weeks: -0.29 SD; 32-<34 weeks: -0.44 SD; 34-<36 weeks: -0.10 SD; 36-<37weeks: -0.11 SD; term-born controls (≥37weeks): 0.02 SD. Corresponding means for zFEV1/FVC were -1.79, -0.44, -0.47, -0.48, -0.29, and -0.02. Adjustment for maternal pregnancy conditions and socioeconomic and lifestyle factors had no major impact on the relationship. Preterm birth is associated with airflow limitation in adult life. The association appears to be attributable predominantly to those born most immature, with only a modest decrease among those born preterm at later gestational ages.

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Section: Discussionmentioning

confidence: 99%

Lung function in adults born preterm

et al. 2018

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“…Factors contributing to chronic lung dysfunction in children with BPD may include nonsynchronous increases in lung size and airway caliber, chronic airway inflammation, air trapping, and emphysematous changes 13,74,75 . The concept of “dysanaptic growth,” meaning a disproportionate growth between lung size and airway caliber, may explain the difference in expiratory flows between individuals with BPD and term‐born ones despite similar lung sizes 76,77 . Dysanapsis may also explain other spirometric alterations characteristic of adult survivors of very preterm birth, with and without BPD, such as a significantly higher average slope ratio throughout the effort‐independent portion of the maximal expiratory flow–volume curve compared with adult controls.…”

Section: Respiratory Outcomes and Lung Function In Adolescence And Adulthoodmentioning

confidence: 99%

“… 13 , 74 , 75 The concept of “dysanaptic growth,” meaning a disproportionate growth between lung size and airway caliber, may explain the difference in expiratory flows between individuals with BPD and term‐born ones despite similar lung sizes. 76 , 77 Dysanapsis may also explain other spirometric alterations characteristic of adult survivors of very preterm birth, with and without BPD, such as a significantly higher average slope ratio throughout the effort‐independent portion of the maximal expiratory flow–volume curve compared with adult controls. This higher slope ratio during early expiration may indeed be due to structural and mechanical properties of the airways, 78 and to the persistence of active airway inflammation, as demonstrated by studies on exhaled breath condensate and nitric oxide.…”

Section: Respiratory Outcomes and Lung Function In Adolescence And Adulthoodmentioning

confidence: 99%

Lung growth and pulmonary function after prematurity and bronchopulmonary dysplasia

Moschino

Bonadies

Baraldi

2021

Pediatric Pulmonology

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Bronchopulmonary dysplasia (BPD) still carries a heavy burden of morbidity and mortality in survivors of extreme prematurity. The disease is characterized by simplification of the alveolar structure, involving a smaller number of enlarged alveoli due to decreased septation and a dysmorphic pulmonary microvessel growth. These changes lead to persistent abnormalities mainly affecting the smaller airways, lung parenchyma, and pulmonary vasculature, which can be assessed with lung function tests and imaging techniques. Several longitudinal lung function studies have demonstrated that most preterm‐born subjects with BPD embark on a low lung function trajectory, never achieving their full airway growth potential. They are consequently at higher risk of developing a chronic obstructive pulmonary disease‐like phenotype later in life. Studies based on computer tomography and magnetic resonance imaging, have also shown that in these patients there is a persistence of lung abnormalities like emphysematous areas, bronchial wall thickening, interstitial opacities, and mosaic lung attenuation also in adult age. This review aims to outline the current knowledge of pulmonary and vascular growth in survivors of BPD and the evidence of their lung function and imaging up to adulthood.

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“…This is commonly assumed if flow parameters by pulmonary function testing are disproportionally low compared to the lung volume in the absence of active bronchoconstriction, for example, by a lower than normal FEV 1 /VC ratio, particularly in the presence of a normal FEV 1 . It has been discussed in the context of asthma and obesity, 85 lung growth after pneumonectomy, 86 and in prematurity and bronchopulmonary dysplasia, 87 and it may be hypothesized after congenital diaphragmatic hernia repair, after resection of congenital lung anomalies and with long‐standing tobacco exposure. It implies that hypoplastic conducting airways have limited capacity of catch‐up growth.…”

Section: Developmental Physiology Of the Lung Parenchymamentioning

confidence: 99%

Developmental respiratory physiology

Trachsel

Erb

Hammer

et al. 2021

Pediatric Anesthesia

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Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis-à-vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications.

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Expiratory Flow – Vital Capacity: Airway – Lung Dysanapsis in 7 Year Olds Born Very Preterm?

Cited by 7 publications

References 40 publications

Lung function in adults born preterm

Lung function in adults born preterm

Lung growth and pulmonary function after prematurity and bronchopulmonary dysplasia

Developmental respiratory physiology

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