Pulmonary outcomes in adults with a history of Bronchopulmonary Dysplasia differ from patients with asthma

Abstract

Background: Bronchopulmonary dysplasia (BPD) is a risk factor for respiratory disease in adulthood. Despite the differences in underlying pathology, patients with a history of BPD are often treated as asthmatics. We hypothesized that pulmonary outcomes and health-related quality of life (HRQoL) were different in adults born preterm with and without a history of BPD compared to asthmatics and healthy individuals.

Methods: We evaluated 96 young adults from the LUNAPRE cohort ( clinicaltrials.gov/ct2/show/NCT02923648 ), including 26 individuals born preterm with a history of BPD (BPD), 23 born preterm without BPD (preterm), 23 asthmatics and 24 healthy controls. Extensive lung function testing and HRQoL were assessed.

Results: The BPD group had more severe airway obstruction compared to the preterm-, (FEV_1- 0.94 vs. 0.28 z-scores; p ≤ 0.001); asthmatic- (0.14 z-scores, p ≤ 0.01) and healthy groups (0.78 z-scores, p ≤ 0.001). Further, they had increased ventilation inhomogeneity compared to the preterm- (LCI 6.97 vs. 6.73, p ≤ 0.05), asthmatic- (6.75, p = 0.05) and healthy groups (6.50 p ≤ 0.001). Both preterm groups had lower D_LCO compared to healthy controls (p ≤ 0.001 for both). HRQoL showed less physical but more psychological symptoms in the BPD group compared to asthmatics.

Conclusions: Lung function impairment and HRQoL in adults with a history of BPD differed from that in asthmatics highlighting the need for objective assessment of lung health.

Keywords: Adults; Astma; Bronchopulmonary dysplasia; HRLQoL; Lung function tests; Multiple breath washout; Oscillometry; Spirometry.

Fig. 1

Graphical summery of health related quality of life questionnaires. The boxplots show the median values and IQR for (a): SF-36 physical component, (b): SF-36 mental component and (c): SGRQ total score. *: p ≤ 0.05; **: p ≤ 0.01; ***: p ≤ 0.001 Abbreviations: BPD: bronchopulmonary dysplasia; IQR: inter quartile range; SF-36: 36-item Short-Form Health Survey; SGRQ: Saint George’s Respiratory Questionnaire

Fig. 2

Graphical summery of airflow, ventilation inhomogeneity and gas diffusion. The boxplots show the median values and IQR for (a): FEV₁; (b): FEV_1,/FVC ratio, (c): D_Lco and (d): LCI .*: p ≤ 0.05; **: p ≤ 0.01; ***: p ≤ 0.001 Abbreviations: BPD: bronchopulmonary dysplasia; IQR: inter quartile range; FEV₁: forced expiratory volume in 1 s; FVC: forced vital capacity; D_{Lco adj}: diffusing capacity of the lung for carbon monoxide, adjusted for haemoglobin; LCI: lung clearance index