Thorax · 2026
Determinants of declining lung function trajectories from childhood to adulthood after preterm birth.
СтатьяНазвание и аннотация: Перевод в очереди
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Gibbons James T D, Smith Elizabeth F, Wilson Andrew C, Simpson Shannon J
Аннотация
BACKGROUND: Preterm birth is associated with lifelong respiratory sequelae, yet our understanding of lung function trajectories across the lifespan remains limited. We aimed to identify patterns of spirometry development from childhood to early adulthood in survivors of very preterm birth using novel data-driven methods.
METHODS: In this longitudinal study, 116 individuals born ≤32 weeks' gestation and 39 term-born controls underwent spirometry testing at up to four timepoints between 4-23 years of age. Patterns (trajectories) of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC z-scores were derived using group-based trajectory modelling. Risk factors for declining trajectories were assessed using regression analysis.
RESULTS: Preterm participants followed distinct trajectories including low-declining FEV1 and very-low-declining FEV1/FVC patterns. Term controls remained stable. Trajectory prevalence estimates require caution due to non-random attrition. Higher gestational age (OR 0.70, 95% CI 0.54 to 0.89) and early-childhood FEV1 (OR 0.03, 95% CI 0.00 to 0.17) protected against low-declining FEV1, while asthma diagnosis (OR 5.55, 95% CI 1.51 to 27.4) and chest CT abnormalities increased risk. For FEV1/FVC decline, higher early-childhood FEV1 was protective (OR 0.39, 95% CI 0.19 to 0.68), while bronchodilator responsiveness (OR 7.65, 95% CI 2.58 to 26.7), asthma diagnosis (OR 2.59, 95% CI 1.02 to 6.96) and CT abnormalities increased risk.
CONCLUSIONS: A substantial proportion of very preterm survivors demonstrate progressive airway obstruction between early childhood and young adulthood, highlighting preterm birth as a significant risk factor for early onset chronic obstructive pulmonary disease. Early lung function screening and identifying modifiable risk factors may provide opportunities for intervention before clinically significant airway obstruction develops.
METHODS: In this longitudinal study, 116 individuals born ≤32 weeks' gestation and 39 term-born controls underwent spirometry testing at up to four timepoints between 4-23 years of age. Patterns (trajectories) of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC z-scores were derived using group-based trajectory modelling. Risk factors for declining trajectories were assessed using regression analysis.
RESULTS: Preterm participants followed distinct trajectories including low-declining FEV1 and very-low-declining FEV1/FVC patterns. Term controls remained stable. Trajectory prevalence estimates require caution due to non-random attrition. Higher gestational age (OR 0.70, 95% CI 0.54 to 0.89) and early-childhood FEV1 (OR 0.03, 95% CI 0.00 to 0.17) protected against low-declining FEV1, while asthma diagnosis (OR 5.55, 95% CI 1.51 to 27.4) and chest CT abnormalities increased risk. For FEV1/FVC decline, higher early-childhood FEV1 was protective (OR 0.39, 95% CI 0.19 to 0.68), while bronchodilator responsiveness (OR 7.65, 95% CI 2.58 to 26.7), asthma diagnosis (OR 2.59, 95% CI 1.02 to 6.96) and CT abnormalities increased risk.
CONCLUSIONS: A substantial proportion of very preterm survivors demonstrate progressive airway obstruction between early childhood and young adulthood, highlighting preterm birth as a significant risk factor for early onset chronic obstructive pulmonary disease. Early lung function screening and identifying modifiable risk factors may provide opportunities for intervention before clinically significant airway obstruction develops.