NURTURE INFORMATION HUB
CHRONIC LUNG DISEASE / BRONCHOPULMONARY DYSPLASIA / BPD
Airway obstruction in young adults born extremely preterm or extremely low birth weight in the postsurfactant era
“Young adults born <28 weeks or <1000 g in the surfactant era, particularly those who had bronchopulmonary dysplasia, have substantially reduced airway function compared with controls. Some are destined to develop COPD in later adult life.”
1. Doyle LW, Andersson S, Bush A, et al. Adults born Preterm International Collaboration. Expiratory airflow in late adolescence and early adulthood in individuals born very preterm or with very low birthweight compared with controls born at term or with normal birthweight: a meta-analysis of individual participant data. Lancet Respir Med. 2019 Aug;7(8):677-686. doi: 10.1016/S2213-2600(18)30530-7. Epub 2019 May 8. PMID: 31078498.
This large meta-analysis showed that individuals born very preterm or with very low birth weight are at risk of not reaching their full airway growth potential in early adulthood, and are at risk of chronic obstructive pulmonary disease in later adulthood.
2. Gibson AM, Reddington C, McBride L, Callanan C, Robertson C, Doyle LW. Lung function in adult survivors of very low birth weight, with and without bronchopulmonary dysplasia. Pediatr Pulmonol. 2015 Oct;50(10):987-94. doi: 10.1002/ppul.23093. Epub 2014 Sep 5. PMID: 25195792.
Individuals born very low birth weight continue to have airway obstruction in their mid-20s compared with controls, particularly those who had BPD.
3. Caskey S, Gough A, Rowan S, Gillespie S, Clarke J, Riley M, Megarry J, Nicholls P, Patterson C, Halliday HL, Shields MD, McGarvey L. Structural and Functional Lung Impairment in Adult Survivors of Bronchopulmonary Dysplasia. Ann Am Thorac Soc. 2016 Aug;13(8):1262-70. doi: 10.1513/AnnalsATS.201509-578OC. PMID: 27222921.
Adults born preterm who developed BPD in the newborn period continue to experience respiratory symptoms in young adulthood.
It is noted that most of the research regarding adult outcomes of BPD relates to babies born before surfactant became widely available (early 1990s)- these studies are relevant to individuals with BPD born prior to this time who are now adults. Less information is available about babies born after surfactant was routinely used. However, the recent publication from the post-surfactant era (Doyle, LW, et al. (2019). "Airway obstruction in young adults born extremely preterm or extremely low birth weight in the post surfactant era." Thorax 74(12):1147-1153). This study confirms the results from the presurfactant era, but show that the gap between those born very tiny or early and those born on time or of normal birthweight is wider than it is for those born a little bit bigger or more mature.
Bronchopulmonary Dysplasia (BPD) or also known as ‘chronic neonatal lung disease’, is a type of lung disorder mostly seen in very premature babies (mainly babies born more than 10 weeks early). These babies may receive high levels of oxygen and increased pressure through ventilators, which can cause in lung injury or interfere with lung growth. Many babies born early have immature lungs and may require mechanical ventilation to treat Respiratory Distress Syndrome (RDS) as well as needing prolonged oxygen therapy. RDS is closely linked to the development of BPD, though not all babies with RDS will develop BPD. Bronchopulmonary dysplasia (BPD) is defined as the condition that occurs when babies are still requiring respiratory and/or additional oxygen after reaching 36 weeks’ gestation.
The introduction of surfactant (a substance that helps the small air sacs in the lungs stay open) in the early 1990s helped the treatment of Respiratory Distress Syndrome in babies, meaning that more babies born early could survive. As more infants with BPD now survive to adulthood, it is crucial that we consider the long-term effects on any respiratory deficiencies in adult life. Studies have shown that that those born extremely premature (before 28 weeks) or with extremely low birthweight (under 1000 grams) with BPD have reduced respiratory function compared with those born full term, thus indicating the possible link between lung development in the early years and chronic lung diseases in adulthood. Generally, there are differences between those born prematurely with BPD compared to those born prematurely without BPD. Those born early and small, with BPD have poorer airway growth than those without BPD and are more likely to be predisposed to higher rates of lung diseases in adult life commonly known as chronic obstructive pulmonary disease (COPD) These discoveries have important implications in identifying, treating and managing those at the greatest risk.
Adults who were born very early may have respiratory limits similar to the elderly or those seen in smokers by the time they reach early adulthood.
Some symptoms of chronic obstructive pulmonary disease are:
As we are learning more about the long term affects of being born premature, it is important to seriously consider the long-term implications. It is crucial that you inform your health practitioners about your premature birth and that doctors become more aware of the affect prematurity has on issues such as lung health and conditions. Doctors do not routinely ask about premature birth beyond childhood, but it is pertinent that you are an advocate for your own health. As with many conditions, lifestyle can play a crucial part in chronic conditions which is why making considered health choices is very important. Regular health checks, good diet, not smoking, exercise and keeping up to date with vaccinations will be beneficial.