New research gives clinicians better tools to identify preterm survivors at risk of declining lung health

For decades, a neonatal diagnosis of bronchopulmonary dysplasia (BPD), a chronic lung condition that can develop in babies born too early, has been the primary tool for flagging respiratory risk in preterm survivors.

New research from the Wal-yan Respiratory Research Centre shows that this traditional marker misses many at-risk survivors, and points to a more accurate set of warning signs that can flag declining lung function years before it becomes serious.

The study, published in Thorax, tracked lung function in 116 individuals born at or before 32 weeks’ gestation from early childhood through to young adulthood, alongside 39 full-term born controls. The researchers found that a substantial proportion of people born very preterm followed a trajectory of progressively worsening airway function, resembling the early stages of chronic obstructive pulmonary disease (COPD).

“We know that a BPD diagnosis does increase the risk of reduced lung function and remainsan important indicator of generally poor lung health over time.

However, in this study it did not always predict whose lung function was declining with a large number of people who didn’t have BPD still demonstrating increasing airway obstruction over time,” said Dr James Gibbons, first author on the paper. 

The research identified three factors more strongly correlated with declining lung function trajectories in preterm-born individuals: 

• Lower lung function measured in early childhood 
• A diagnosis of asthma 
• Structural abnormalities visible on CT imaging 

“Together, these factors give clinicians a more accurate set of indicators for identifying preterm survivors who may be on a path toward significant airway obstruction, and who might benefit from closer monitoring or earlier intervention,” said Dr Gibbons.

One of the barriers to earlier identification is that many preterm-born individuals have lived with respiratory symptoms for so long that they do not recognise them as abnormal.

“These people grow up not knowing necessarily that anything is wrong. Everything is normal to them because they’ve always been a bit short of breath or they’ve always been a bit wheezy,” said Dr Gibbons.

That is what makes these findings significant. Rather than relying on self-reported symptoms, clinicians now have a set of measurable, observable factors they can use to identify at-risk individuals earlier and with greater confidence. 

Currently there is no standard respiratory follow-up program for preterm survivors in Australia, despite this research suggesting a significant proportion may have declining lung function going undetected. Families can support earlier identification by: 

• Informing GPs and specialists of a preterm birth history, particularly if there are any respiratory symptoms 
• Asking about spirometry testing if a child is aged six or older 
• Requesting a specialist referral if concerns remain 

The Foundations of Lung Disease team at the Wal-yan Respiratory Research Centre is working towards a more systematic solution, with early-stage discussions underway around a WA state-based screening program. At an international level, Associate Professor Shannon Simpson, senior author of the paper and co-head of the Foundations of Lung Disease team, co-chairs the PELICAN group, which is developing model-of-care recommendations for this population across different healthcare systems.

This research brings clinicians and families an important step closer to identifying who needs support and acting early enough to make a difference. 

The Wal-yan Respiratory Research Centre is a powerhouse partnership between The Kids Research Institute Australia, Perth Children’s Hospital and Perth Children’s Hospital Foundation.