Increasing airway obstruction through life following bronchopulmonary dysplasia: a meta-analysis

Abstract

Few studies exist investigating lung function trajectories of those born preterm, however growing evidence suggests some individuals experience increasing airway obstruction throughout life. Here we use the studies identified in a recent systematic review to provide the first meta-analysis investigating the impact of preterm birth on airway obstruction measured by the FEV1/FVC ratio.Cohorts were included for analysis if they reported FEV1/FVC in survivors of preterm birth (<37 weeks’ gestation) and control populations born at term. Meta-analysis was performed using a random effect model, expressed as standardised mean difference (SMD). Meta-regression was conducted using age and birth year as moderators.55 cohorts were eligible, 35 of which defined groups with bronchopulmonary dysplasia (BPD). Compared to control populations born at term, lower values of FEV1/FVC were seen in all individuals born preterm (SMD −0.56), with greater differences seen in those with BPD (SMD −0.87) than those without BPD (SMD −0.45). Meta-regression identified age as a significant predictor of FEV1/FVC in those with BPD with the FEV1/FVC ratio moving −0.04 SDs away from the term control population for every year of increased age.Survivors of preterm birth have significantly increased airway obstruction compared to those born at term with larger differences in those with BPD. Increased age is associated with a decline in FEV1/FVC values suggesting increased airway obstruction over the life course.

Pulmonary Function and Bronchopulmonary Dysplasia Classification: Insights from the Spanish Registry

“…Air ow obstruction is a common impairment associated with prematurity, particularly prevalent in patients diagnosed with BPD, and tends to persist into adulthood, as indicated by a recent meta-analysis [27]. This obstruction often arises from a mismatch between distal airway growth and lung volume, known as dysanapsis, resulting from disruptions in normal pulmonary development [28,29].…”

“…While some studies suggest improved long-term respiratory outcomes in contemporary cohorts of preterm infants compared with earlier populations [18,34]. others show no differences [27,35,36].…”

Perception of quality of life in school-age children born before 32 weeks of gestational age

“…Despite recent advancements in the survival rates of extremely preterm infants, the prevalence of respiratory sequel, particularly BPD, remains high (1,2). Prior research indicates that patients diagnosed with BPD are at an increased risk of asthma and pulmonary function abnormalities compared to those without BPD (5,(19)(20)(21)(22). However, there is no established consensus on the impact of this condition on quality of life.…”

Evolving treatment for prematurity-associated lung disease

“…The Respiratory Health Outcomes in Neonates (RHiNO) study has recently demonstrated that there are multiple spirometry phenotypes of PLD, including both fixed and reversible prematurity-associated obstructive lung disease (POLD), prematurity-associated preserved ratio with impaired spirometry (pPRISm) and dysanaptic spirometry patterns, which are differentially associated with early- and current-life factors, including BPD ( 6 ). There is an increasing concern that PLD may predispose an individual to the premature development of chronic obstructive pulmonary disease (COPD) in early adulthood ( 7 , 8 ), with implications for quality of life and life expectancy if lung function deficits continue to track into adulthood. Whilst much research focus has concentrated on the mechanism of respiratory morbidity in those with a history of BPD ( 9 , 10 ), it is increasingly apparent that there is a population of preterm-born subjects who develop PLD despite not having had a diagnosis of BPD in the neonatal period ( 3 , 11 ), with impaired spirometry, altered respiratory mechanics and reduced gas diffusion capacity ( 12 ).…”