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Impaired exercise outcomes with significant bronchodilator responsiveness in children with prematurity-associated obstructive lung disease

Cousins, Michael, Hart, Kylie, Williams, E. Mark and Kotecha, Sailesh ORCID: 2022. Impaired exercise outcomes with significant bronchodilator responsiveness in children with prematurity-associated obstructive lung disease. Pediatric Pulmonology 57 (9) , pp. 2161-2171. 10.1002/ppul.26019

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Introduction Preterm-born children have their normal in-utero lung development interrupted, thus are at risk of short- and long-term lung disease. Spirometry and exercise capacity impairments have been regularly reported in preterm-born children especially those who developed chronic lung disease of prematurity (CLD) in infancy. However, specific phenotypes may be differentially associated with exercise capacity. We investigated exercise capacity associated with prematurity-associated obstructive (POLD) or prematurity-associated preserved ratio of impaired spirometry (pPRISm) when compared to preterm- and term-controls with normal lung function. Materials and Methods Preterm- and term-born children identified through home screening underwent in-depth lung function and cardiorespiratory exercise testing, including administration of post-exercise bronchodilator, as part of the Respiratory Health Outcomes in Neonates (RHiNO) study. Results From 241 invited children, aged 7 – 12 years, 202 underwent exercise testing including 18 children with POLD (percent predicted (%)FEV1 and FEV1/FVC90%). POLD children had reduced relative workload, and peak O2 uptake, CO2 production and minute ventilation compared to Tc, and used greater proportion of breathing reserve compared to both control groups. pPRISm and PTc children also had lower O2 uptake compared to Tc. POLD children had the greatest response to post-exercise bronchodilator, improving their %FEV1 by 19.4% (vs 6.3%/6%/6.3% in pPRISm/PTc/Tc respectively; p<0.001). Conclusion Preterm-born children with obstructive airway disease had the greatest impairment in exercise capacity, and significantly greater response to post-exercise bronchodilators. These classifications can be used to guide treatment in children with POLD.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Wiley
ISSN: 8755-6863
Funders: MRC
Date of First Compliant Deposit: 8 June 2022
Date of Acceptance: 30 May 2022
Last Modified: 24 May 2023 17:51

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