Preterm birth and asthma and COPD in adulthood: a nationwide register study from two Nordic countries

Abstract

Preterm birth affects lungs in several ways but only 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. We used nationwide register 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 2005–2016 and in Norway 2008–2017. We used logistic regression to estimate odds ratios (OR) for having a care episode with either disease outcome. Odds of any obstructive airway disease in adulthood were 2–3-fold for those born <28 or 28–31 completed weeks, compared with 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 <28 weeks, 3.18 (2.23–4.54) for those born 28–31 weeks, and 2.32 (1.72–3.12) for those born 32–33 weeks. Bronchopulmonary dysplasia in infancy increased the odds further for those born <28 and 32–31 weeks. Preterm birth is a risk factor for asthma and COPD in adulthood. The high odds of COPD calls for diagnostic vigilance when adults born very preterm present with respiratory symptoms.

Atopic diseases in pediatric population: prematurity and small for gestational age

“…In our study, prematurity was positively related to the future development of asthma and AR in the pediatric population, while being protective against the development of AD. These results are consistent with ndings from other nationwide databases or reviews on asthma and AD, with a stronger correlation observed as gestational age decreases 6, [15][16][17] . Although beyond the scope of this study, the possible etiology of prematurity-associated asthma is multifactorial.…”

Gestational age at birth and hospitalisations for infections among individuals aged 0–50 years in Norway: a longitudinal, register-based, cohort study

“…The link between preterm birth and long-term risk of respiratory infections, particularly lung infections, seems plausible because preterm birth is strongly associated with lung immaturity and the need of ventilatory support in the neonatal period. 33 For preterm born, lower lung volumes and higher rates of chronic lung disease have been reported through childhood and into adulthood, 33 , 34 , 35 , 36 , 37 , 38 and associations between preterm birth and RTI risk in childhood and adolescence have been described previously. 25 , 28 , 34 , 36 Reduced respiratory organ function and chronic lung disease increase the risk of RTIs in children as well as in adults, and an increased risk of chronic lung disease (CLD) in childhood and adulthood may, at least in part, mediate the excess RTI risk in children and adults born preterm.…”

“… 25 , 28 , 34 , 36 Reduced respiratory organ function and chronic lung disease increase the risk of RTIs in children as well as in adults, and an increased risk of chronic lung disease (CLD) in childhood and adulthood may, at least in part, mediate the excess RTI risk in children and adults born preterm. 38 However, the increased risk of RTI and CLD in children born preterm are likely intertangled and cannot be solely explained by structural changes in the lung. Although the precise mechanisms are not yet fully understood, it is likely that the development of lung disease in early life is also connected to the establishment of the microbiota and the maturation of the immune system.…”

ERS International Congress 2023: highlights from the Basic and Translational Sciences Assembly

“…R. Faner Canet (Barcelona, Spain) discussed the importance of gene–environment interactions in the pathogenesis of COPD. Being born severely preterm (<28 weeks gestational age) is associated with a 7-fold increased risk of developing COPD by age 30–50 years [ 32 ]. This links to another study of preterm children who underwent COPD polygenic risk scoring.…”