CHRONIC LUNG DISEASE OF PREMATURITY:
LONG-TERM RESPIRATORY OUTCOME
Eugenio Baraldi, MD
Department of Pediatrics, University of Padova, Italy
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease that develops as a
consequence of perinatal/neonatal lung injury, and it is one of the most important
sequelae of premature birth. The diagnosis of BPD is currently based on the need for
supplemental oxygen for at least 28 days after birth, and its severity is graded according
to the respiratory support required at 36 postmenstrual weeks. BPD almost always occurs
in neonates who are delivered at a gestational age of less than 30 weeks and who have a
birth weight of less than 1500 g. These are about 1.5% of all newborns and BPD develops
in about 20% of them. Today BPD is mainly a developmental disorder in which the
immature lung fails to reach its full structural complexity. Longitudinal studies on children
with BPD identified, at all ages, increased rates of chronic coughing and wheezing, a
greater need to use inhaled asthma medications and a significant airflow obstruction.
Children
who have survived BPD and children with asthma share some clinical and
functional characteristics, but available evidence suggests that the two obstructive lung
diseases do not have the same underlying airway inflammation. Spirometric values
reflecting airflow, such as FEV1, are consistently lower in survivors of BPD into
adolescence and young adulthood than in controls born at term rising the concern that the
chronic lung disease after premature birth may predispose to the development of a
chronic obstructive pulmonary disease (COPD)-like phenotype with aging. This is an open
question that only follow-up and lung function studies extended to middle-age and beyond
will answer. Unfortunately, no pathologic data are available elucidating which structural
and pathophysiological alterations underlie the clinical and functional pulmonary
abnormalities seen at long-term in some subjects delivered prematurely. A relevant
question is whether the long-term pulmonary consequences of prematurity and BPD
essentially depend on a non-progressive reduction of the airway caliber, due to a
stabilized, non-progressive structural damage of the airways, or instead also reflect an
active airway disease. Chronic lung disease of prematurity can no longer be considered
only a pediatric disease and also family doctors and chest physicians should be aware of
this “new” Chronic Obstructive Pulmonary Disease.
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