What Happens to Lung Function With Bronchopulmonary Dysplasia?

Deborah A. Gerbert, MS, PA-C

Disclosures

June 13, 2001

Question

What are the long-term outcomes of individuals suffering from bronchopulmonary dysplasia?

Bryce Cook, PA-C

Response from Deborah A. Gerbert, MS, PA-C

Bronchopulmonary dysplasia (BPD) was first described in 1967 as a syndrome of chronic lung disease in prematurely born infants who had been treated for respiratory distress syndrome with supplemental oxygen and mechanical ventilation. At that time the infants identified had gestational ages of 33.2 +/- 3.8 weeks and weighed 1894 g +/- 703 g. By today's neonatal practices these babies are quite mature. A majority of the infants diagnosed with BPD in the late 1960s and 1970s are now reaching adulthood.[1]

Only 1 study has carefully examined the late pulmonary sequelae of BPD. This study,[2] published in 1990, followed 26 adolescents and young adults, born between 1964 and 1973, who had BPD in infancy. These patients were compared with 26 age-matched adolescents and young adults of similar birth weight and gestational age who had not undergone mechanical ventilation and with 53 age-matched normal subjects. Pulmonary-function studies included spirometry, flow-volume curves, functional residual capacity, single-breath nitrogen washout, low-density gas spirometry, and bronchial provocation with methacholine.

Clinical findings among the studies' subjects showed that those with BPD had had more wheezing, episodes of pneumonia, limitation of exercise capacity, and long-term medication use than the matched cohort controls or the normal controls.

Seventy-six percent of the subjects with BPD had pulmonary dysfunction. Abnormalities consisted of airway obstruction, airway hyperreactivity and hyperinflation. There were statistically significant decreases in peak expiratory flow rate, forced vital capacity, FEV1, FEF(25-75) (forced expiratory flow between 25% and 75% of total predicted capacity),and maximal expiratory flow velocity at 50% of vital capacity; 24% had fixed airway obstruction and 52% had reactive airway disease.

Most abnormalities in pulmonary function in the subjects with BPD were mild to moderate. The individuals were usually asymptomatic. Although most were leading normal lives, the pulmonary dysfunction causes concern about their susceptibility to progressive obstructive pulmonary disease as they age. More recent studies to follow up these early cases of BPD have not been done. With the introduction of surfactant therapy for the premature lung, the incidence of severe BPD has declined, but is still present. Smaller and smaller babies are surviving, but what their pulmonary function will be in their adult years is as yet unknown.

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