P76 General and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia: a systematic review

Abstract

2001e2 to 16% in 2005e6, p<0.001) for children at all treatment steps including those prescribed short acting beta agonist only. Only 27 children were prescribed LABA without concurrent ICS and of the 710 children prescribed LABA/ICS combination, 176 (25%) had not been prescribed ICS in the previous year. Conclusions Revisions of the BTS/SIGN guidelines do modify prescribing practice in children. The greater use of LABA, LTRA and reduction in ICS dose has been accompanied by a greater use of OCS that may reflect poorer control of acute episodes or a lower threshold and greater confidence by prescribers in the use of OCS. Introduction and objectives Bronchopulmonary dysplasia (BPD) is the most common form of chronic lung disease in infancy and the second most common after asthma in children. With the improved survival of extremely preterm infants the incidence of BPD has increased. Currently there is only limited information on the health of BPD survivors who have reached adulthood. The purpose of this systematic literature review was to examine current empirical research on adult survivors of BPD. Methods Six electronic databases were searched between 1950 and February 2010 (Medline, PubMed, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL Plus) and Web of Knowledge. Studies were independently screened and were only included if they related to the assessment of outcome measures in adult survivors of BPD. From a total of 1453 search results, 14 eligible studies were included in the review. Data on methodological design and findings were extracted from each included study; in addition the methodological quality of each study was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Results 14 cohort studies met the review criteria. 12 scored highly on the CASP checklist, with a score >10 out of 12. No study scored less than 7. Nine studies included a control group and only four studies in total had a singular focus on BPD outcomes. Six controlled studies found differences between the groups on respiratory symptoms. 11 studies carried out lung function testing and found evidence of airflow obstruction. Of these, one study found no difference between preterm and controls. However, there were only seven adults who were born preterm with BPD in this study. Five studies in total examined radiographical outcomes, and all found evidence of abnormalities. Those with moderate-severe BPD were found to be most affected compared to mild BPD subjects.Conclusions The effects of BPD on pulmonary function do not diminish over time. This may reflect issues related to means of testing, differing definitions and classification of BPD, and the adaptation of individuals to their circumstances over time. P77CHILDREN'S EXPOSURE TO AIRBORNE FINE PARTICULATE MATTER AT HOME AND ASTHMA OUTCOMES Objectives The relationship between indoor air exposure to fine particulate (PM 2.5 ) and asthma symptoms in children is uncertain.The aim of the present study was to relate PM 2.5 exposure to indi...

Preterm birth: risk factor for early-onset chronic diseases

“…30,31 Systematic reviews have reported abnormal pulmonary function testing, consistent with airflow limitation in the proximal and more distal airways, among adults born preterm, as evidenced by reduced forced expiratory volume in 1 second (FEV 1 ), forced vital capacity (FVC) and forced mid-expiratory flow. 29,32 Forced expiratory volume was 0.77 standard deviations (SDs) (95% CI -0.94 to -0.60) lower in young adults who were born preterm than in those born at term, which is equivalent to a 10% decrease in predicted value. 32 Patients with BPD had even greater reductions in FEV 1 compared with those without the disease (MD -0.83 SD, 95% CI -1.01 to -0.64).…”

“…29 About 10% of adults who were born preterm use bronchodilators and inhaled corticosteroids, compared with 4%-6% of those born at term. 30,31 Systematic reviews have reported abnormal pulmonary function testing, consistent with airflow limitation in the proximal and more distal airways, among adults born preterm, as evidenced by reduced forced expiratory volume in 1 second (FEV 1 ), forced vital capacity (FVC) and forced mid-expiratory flow.…”

“…At the alveolar level, impaired gas transfer has been documented with lower diffusion capacity in patients born preterm. 29 Radiological studies using chest computed tomography have almost universally described abnormal findings, including fibrosis, air trapping and even emphysema, in patients with BPD and in most preterm infants without BPD born at or before 28 weeks' gestation. 29,35 Peak lung growth and function are reached in the 20s before natural age-related decline takes place.…”

“…29 Radiological studies using chest computed tomography have almost universally described abnormal findings, including fibrosis, air trapping and even emphysema, in patients with BPD and in most preterm infants without BPD born at or before 28 weeks' gestation. 29,35 Peak lung growth and function are reached in the 20s before natural age-related decline takes place. Patients with BPD or people born preterm who smoke have a greater decline in the ratio of FEV 1 to FVC between the ages of 8 and 18 years.…”

Lung Function in Very Low Birth Weight Adults

“…5 Much of the existing evidence focuses on adults with a history of BPD, who do have more pulmonary symptoms and respiratory function abnormalities (including obstructed airflow) than those born at term. 2,[6][7][8][9][10][11][12] Whether this outcome applies to adults born preterm at VLBW who have no history of BPD is less conclusive. Most studies may not include a sufficient number of subjects to distinguish between those with a history of BPD and those without.…”