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Lung consequences in adults born prematurely
  1. Charlotte E Bolton1,2,
  2. Andrew Bush3,4,
  3. John R Hurst5,
  4. Sailesh Kotecha6,
  5. Lorcan McGarvey7,8
  1. 1Nottingham Respiratory Research Unit, School of Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
  2. 2Department of Respiratory Medicine, Nottingham University Hospitals Trust, Nottingham, UK
  3. 3Department of Paediatric Respirology, National Heart and Lung Institute, Imperial College, London, UK
  4. 4Department of Paediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust, London, UK
  5. 5Department of Respiratory Medicine, Royal Free Campus, University College London, London, UK
  6. 6Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
  7. 7Department of Respiratory Medicine, Centre for Infection and Immunity, Queen's University Belfast, UK
  8. 8Department of Respiratory Medicine, Royal Victoria Hospital, Belfast Health Social Care Trust, Belfast, UK
  1. Correspondence to Dr Charlotte E Bolton, Nottingham Respiratory Research Unit, School of Medicine, University of Nottingham, City Hospital Campus, Hucknall road, Nottingham NG5 1PB, UK; charlotte.bolton{at}nottingham.ac.uk

Abstract

Although survival has improved significantly in recent years, prematurity remains a major cause of infant and childhood mortality and morbidity. Preterm births (<37 weeks of gestation) account for 8% of live births representing >50 000 live births each year in the UK. Preterm birth, irrespective of whether babies require neonatal intensive care, is associated with increased respiratory symptoms, partially reversible airflow obstruction and abnormal thoracic imaging in childhood and in young adulthood compared with those born at term. Having failed to reach their optimal peak lung function in early adulthood, there are as yet unsubstantiated concerns of accelerated lung function decline especially if exposed to noxious substances leading to chronic respiratory illness; even if the rate of decline in lung function is normal, the threshold for respiratory symptoms will be crossed early. Few adult respiratory physicians enquire about the neonatal period in their clinical practice. The management of these subjects in adulthood is largely evidence free. They are often labelled as asthmatic although the underlying mechanisms are likely to be very different. Smoking cessation, maintaining physical fitness, annual influenza immunisation and a general healthy lifestyle should be endorsed irrespective of any symptoms. There are a number of clinical and research priorities to maximise the quality of life and lung health in the longer term not least understanding the underlying mechanisms and optimising treatment, rather than extrapolating from other airway diseases.

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