Emphysema in young adult survivors of moderate to severe bronchopulmonary dysplasia

¹ Advanced Lung Disease Program, Royal Perth Hospital, Western Australia; and Lung Institute of Western Australia, Sir Charles Gairdner Hospital, Western Australia
² Advanced Lung Disease Program, Royal Perth Hospital, Western Australia
³ Dept of Diagnostic Imaging, Royal Perth Hospital, Western Australia
⁴ Neonatal Critical Care Unit, King Edward Memorial Hospital, Western Australia
⁵ Dept of Respiratory Medicine, Royal Perth Hospital, Western Australia.
⁶ Advanced Lung Disease Program, Royal Perth Hospital, Western Australia; and Dept of Respiratory Medicine, Royal Perth Hospital, Western Australia.
⁷ Advanced Lung Disease Program, Royal Perth Hospital, Western Australia; Lung Institute of Western Australia, Sir Charles Gairdner Hospital, Western Australia; and Thoracic Dept, The Prince Charles Hospital, Queensland

^* To whom correspondence should be addressed. E-mail: Daniel_Chambers{at}health.qld.gov.au.

	Abstract

Improved survival following extreme preterm birth complicated by bronchopulmonary dysplasia (BPD) is resulting in an increasing number of affected infants surviving to adulthood. The aim of this pilot study was to describe the functional and structural pulmonary sequelae of moderate and severe BPD in a population of adult survivors.

All babies were cared for at one institution. Subjects born 1980–1987 with birthweight less than 1500g and requiring supplementary oxygen at 36 weeks post-menstrual age were identified from a complete neonatal database and recruited prospectively. Local physicians were concurrently asked to refer suitable patients. Demographics, respiratory symptoms and examination, pulmonary function tests and computed tomography images were acquired.

21 subjects (12 female, median age 19, range 17–33) were studied. 15 (71%) had persistent respiratory symptoms. Median FEV₁ z-score was -0.77 (-8.20 – 1.37), FEF_25–75 -1.81 (-6.00 – 0.75) and DL_CO -5.04 (-13.17 – -1.24). 19 subjects underwent CT and all had abnormal findings, with emphysema being the most common, present in 84% of subjects. The extent of radiologic emphysema was inversely related to FEV₁ z-score (R²=0.50, p < 0.01).

Young adult survivors of moderate and severe BPD may be left with residual functional and characteristic structural pulmonary abnormalities, most notably emphysema.