Management of Prematurity-Associated Wheeze and Its Association with Atopy

Abstract

IntroductionAlthough preterm birth is associated with respiratory morbidity in childhood, the role of family history of atopy and whether appropriate treatment has been instituted is unclear. Thus we assessed (i) the prevalence of respiratory symptoms, particularly wheezing, in childhood; (ii) evaluated the role of family history of atopy and mode of delivery, and (iii) documented the drug usage, all in preterm-born children compared to term-born control children.MethodsWe conducted a cross-sectional population-based questionnaire study of 1–10 year-old preterm-born children (n = 13,361) and matched term-born controls (13,361). Data (n = 7,149) was analysed by gestational groups (24–32 weeks, 33–34 weeks, 35–36 weeks and 37–43 weeks) and by age, <5 years old or ≥ 5 years.Main ResultsPreterm born children aged <5 years (n = 2,111, term n = 1,402) had higher rates of wheeze-ever [odds ratio: 2.7 (95% confidence intervals 2.2, 3.3); 1.8 (1.5, 2.2); 1.5 (1.3, 1.8) respectively for the 24–32 weeks, 33–34 weeks, 35–36 weeks groups compared to term]. Similarly for the ≥5 year age group (n = 2,083, term n = 1,456) wheezing increased with increasing prematurity [odds ratios 3.3 (2.7, 4.1), 1.8 (1.5, 2.3) and 1.6 (1.3, 1.9) for the three preterm groups compared to term]. At both age groups, inhaler usage was greater in the lowest preterm group but prematurity-associated wheeze was independent of a family history of atopy.ConclusionsIncreasing prematurity was associated with increased respiratory symptoms, which were independent of a family history of atopy. Use of bronchodilators was also increased in the preterm groups but its efficacy needs careful evaluation.

The impact of respiratory viruses on lung health after preterm birth

“…Indeed, even in healthy term-born infants, hospitalisation with acute respiratory viruses in early life is associated with increased rates of childhood asthma, wheezing disorders and suboptimal lung function [29–31]. While preterm infants are often labelled as asthmatic, the underlying mechanisms of prematurity associated wheeze are likely to be different [32] although the long-term implications of exposure to acute respiratory viruses during early life remains to be elucidated in the preterm population. The following sections will review what is known about the burden and consequences of early-life infection with respiratory viruses among preterm infants.…”

Effect of fetal and infant growth on respiratory symptoms in preterm‐born children

“…Respiratory outcome data from RANOPS, a cross‐sectional population study of preterm‐born children, were used. Briefly, in 2013, all live‐born preterm (<37 weeks’ gestation) surviving children born in Wales aged between 1 and 10 years, and term controls (born same gender, day, and locality) were sent the Liverpool Respiratory Symptom Questionnaire (if <5 years of age) or a modified ISAAC Questionnaire (if ≥5 years of age), n = 23 722 . There were 7148/26 741 (27%) responders to the questionnaire survey (32% in the preterm‐born group).…”

“…Both questionnaires have been validated . Data from all responders were used in the analyses as we have previously reported similar characteristics between matched responders and all responders . Ethical approval for the survey was obtained from the Research Ethics Committee and parents gave consent for use of their data, and for healthcare database linkage, by returning completed questionnaires.…”

“…Respiratory outcomes were extracted from the RANOPS questionnaires which included wheeze‐ever, recent wheeze (last 3 months for <5 years of age; last 12 months for ≥5 years of age), use of inhalers, hospital admissions for chest‐related problems, and doctor‐diagnosed asthma (≥5 years of age only). All outcomes were dichotomous . Rates of maternal smoking during pregnancy and current smoking were also taken from the RANOPS questionnaire.…”

“…Preterm‐born (<37 weeks’ gestation) children are at an increased risk of respiratory symptoms, hospital admissions and reduced lung function in childhood and beyond . These risks persist into adulthood potentially developing into early‐onset chronic obstructive pulmonary disease …”