Jennifer S. Landry

Long-Term Impact of Bronchopulmonary Dysplasia on Pulmonary Function

BACKGROUND Bronchopulmonary dysplasia (BPD) and the longterm respiratory consequences of prematurity are unfamiliar to adult respirologists and remain under-recognized entities to adult caregivers. In Canada, the incidence of preterm births and its main chronic respiratory complication, BPD, have increased over the past 25 years. OBJECTIVE To describe the posthospitalization morbidity, medication use, health care use and pulmonary function tests of a large cohort of individuals with preterm birth complicated by BPD. METHODS A retrospective review of the hospital records of 322 preterm infants with BPD was conducted. Outcome variables were compared across levels of disease severity. Differences between groups were tested with one-way ANOVA for continuous variables and the Mantel-Haenszel chi-squared test for ordinal variables. RESULTS Outcomes after the initial hospitalization that were associated with the initial severity of BPD were as follows: hospital readmissions in the first two years of life, the presence of developmental delay, forced expiratory volume in 1 s and forced vital capacity on pulmonary function tests in patients between eight and 15 years of age. CONCLUSION Initial BPD severity was an important predictor of pulmonary function abnormality and health care use during childhood.

Lung Function and Bronchial Hyperresponsiveness in Adults Born Prematurely. A Cohort Study

RATIONALE Bronchopulmonary dysplasia and the long-term consequences of prematurity are underrecognized entities, unfamiliar to adult clinicians. Well described by the pediatric community, these young adults are joining the ranks of a growing population of adults with chronic lung disease. OBJECTIVES To describe the quality of life, pulmonary lung function, bronchial hyperresponsiveness, body composition, and trends in physical activity of adults born prematurely, with or without respiratory complications. METHODS Four groups of young adults born in Canada between 1987 and 1993 were enrolled in a cohort study: (1) preterm subjects with no neonatal respiratory complications, (2) preterm subjects with neonatal respiratory distress syndrome, (3) preterm subjects with bronchopulmonary dysplasia, and (4) subjects born at term. The following measurements were compared across the four groups: health-related quality of life, respiratory health, pulmonary function, methacholine challenge test results, and sedentary behavior and physical activity level. MEASUREMENTS AND MAIN RESULTS Adult subjects who had bronchopulmonary dysplasia in infancy had mild airflow obstruction (FEV1, 80% predicted; FEV1/FCV ratio, 70) and gas trapping compared with others. They also had less total active energy expenditure and more time spent in sedentary behavior compared with subjects born at term. All preterm groups had a high prevalence of bronchial hyperresponsiveness compared with term subjects. CONCLUSIONS In a population-derived, cross-sectional study, we confirmed previous reports that adults 21 or 22 years of age who were born prematurely with neonatal bronchopulmonary dysplasia are more likely to have airflow obstruction, bronchial hyperresponsiveness, and pulmonary gas trapping than subjects born prematurely without bronchopulmonary dysplasia or at term. Clinicians who care for adults need to be better informed of the long-term respiratory consequences of premature birth to assist young patients in maintaining lung function and health.

Health care utilization by preterm infants with respiratory complications in Quebec.

INTRODUCTION Despite notable advances in prenatal and neonatal care, respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) remain important complications of preterm births, and their long-term sequelae are poorly understood. OBJECTIVE To describe health care utilization and costs over a 16- to 25-year follow-up period in a cohort of preterm infants with respiratory complications. METHODS Using provincial health administrative databases from Quebec, a cohort of individuals who were born prematurely with complications of RDS and⁄or BPD between 1983 and 1992 were identified. From these databases, which cover all Quebec residents, health services use, medication prescriptions, associated diagnoses and costs were tabulated. RESULTS A total of 3442 subjects with respiratory complications following preterm birth were identified, of whom 773 had been diagnosed with BPD and 2669 had RDS without BPD. Asthma was diagnosed twice as frequently (1.7 to 2.4 times) in the BPD group compared with the RDS group, with more frequent hospital readmission, and outpatient and emergency room visits. Although respiratory causes remained the main reason for consultation in both groups, 3.7% and 3.4% of the outpatient visits were for mental or psychological ailments, such as depression, attention deficit hyperactivity disorder or dysthymia for the BPD and RDS groups, respectively. CONCLUSION BPD patients experienced more hospital admissions, outpatient and emergency rooms visits, and were more likely to suffer from respiratory illnesses and to use respiratory drugs than RDS patients. Neurological and psychiatric complications occurred at a high frequency in both RDS and BPD subjects, and were associated with significant use of antipsychotic and antidepressant medications.

Healthcare utilization and health-related quality of life of adult survivors of preterm birth complicated by bronchopulmonary dysplasia.

This study aims to characterize the impact of preterm birth, respiratory distress syndrome and bronchopulmonary dysplasia on quality of life and healthcare utilization in adulthood.

C-Reactive Protein in Stable Cystic Fibrosis: An Additional Indicator of Clinical Disease Activity and Risk of Future Pulmonary Exacerbations

Introduction In stable adult cystic fibrosis (CF) patients, we assessed the role of baseline high sensitivity C-reactive protein (hs-CRP) on CF clinical variables and frequency of intravenous (IV) treated pulmonary exacerbations (PExs) 1-year post-baseline. Methods We recruited 51 clinically stable CF patients from our Adult CF Center. We incorporated collected parameters into Matouk CF clinical score and CF questionnaire-revised quality of life score (QOL). We used the clinical minus complications subscores as a clinical disease activity score (CDAS). We dichotomized our patients according to the cohort median baseline hs-CRP of 5.2 mg/L. Results Patients in the high hs-CRP group (≥ 5.2 mg/L) demonstrated worse CDAS (r=0.67, p=0.0001) and QOL scores (r=0.57, p=0.0017) at a given FEV1% predicted. In both hs-CRP groups, prior-year IV-treated PExs and baseline CDASs were significant predictors of future IV-treated PExs. Interestingly, the association between baseline CDAS and future PExs frequency was more robust in the high compared to the low hs-CRP group (r=−0.88, p<0.0001, r=−0.48, p=0.017, respectively) with a steeper regression slope (p=0.001). In addition, a significant interaction was demonstrated between elevated baseline hs-CRP levels and CDASs for the prediction of increased risk of future PExs (p=0.02). This interaction provided an additional indicator of clinical disease activity and added another dimension to the prior year PExs frequency phenotype to identify patients at increased risk for future PExs. Conclusion Stable CF patients with elevated baseline hs-CRP (≥ 5.2 mg/L) demonstrated worse clinical disease activity and QOL scores at a given level of disease severity (FEV1% predicted). Elevated baseline hs-CRP values combined with clinical disease activity scores are associated with increased risk for future IV-treated PExs even in those with mild clinical disease activity scores.

Pulmonary Function in Survivors of Bronchopulmonary Dysplasia

With advances in neonatal care over the last three decades, a greater proportion of preterm infants are surviving the initial complications of prematurity and are now reaching adulthood in ever increasing numbers. The impact of preterm birth and its respiratory complications have lasting consequences on respiratory health. Bronchopulmonary dysplasia (BPD) and the long-term respiratory consequences of prematurity are unfamiliar and under-recognized entities to adult clinicians. Well described by the pediatric scientific community, these young adults who were born prematurely and suffered respiratory complications are joining the rank of a growing population of adults with chronic lung disease.

The Long-term Impacts of Birth Weight and Respiratory Complications after a Preterm Birth

Background: Infant respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) remain important respiratory complications of preterm births. This study aims at establishing the incidence and impact of respiratory complications and extreme low birth weight (ELBW) on the healthcare utilization of a population of preterm infants. Methods: Retrospective cohort study using administrative healthcare databases of the province of Quebec (Canada). The main outcome measures of healthcare utilization, hospital admissions, hospital mortality and use of prescription drugs were studied in 55 033 subjects born prematurely with or without respiratory complications such as BPD or RDS between 1999 and 2009. Results: Preterm infants with BPD and RDS had significantly higher hospital readmissions per person-year. This trend persisted for the entire duration of the 10-year follow-up. Diagnoses of childhood asthma, attention deficit hyperactivity disorder and cerebral palsy were more frequent in BPD subjects, but were not influenced by birth weight. Extreme low birth weight carried odds ratio of 38.0 [33.5, 43.2] and 3.5 [3.2, 3.9] respectively for the occurrence of BPD and RDS, and was associated with greater mortality, longer hospital stay and more medical visits per person-year. Except for anxiolytics and sedatives, bronchopulmonary dysplasia subjects were not more likely to have been prescribed neurological and psychiatric medications. Conclusions: Birth weight is a major determinant in the occurrence of respiratory complications following a preterm birth. The impacts of BPD and extreme low birth weight following a preterm birth have lasting consequences on respiratory health and healthcare utilization.