Abstract

Bronchopulmonary dysplasia (BPD) in infancy is a risk factor for obstructive lung disease in adults. We hypothesized that adults born preterm and diagnosed with BPD have an altered lung architecture which is correlated to lung function impairment.

Individuals from the LUNAPRE cohort (clinicaltrials.gov/ct2/show/NCT02923648) were included: preterm born (gestational week <32) with (n=24) or without (n=23) a previous diagnosis of BPD, full term born with allergic asthma (n=22) and healthy volunteers (n=24). Inspiratory and expiratory HRCT scans were performed and interpreted by two expert reviewers in a blinded manner. Structural changes were scored and quantitative density measurements were analysed automatically using a dedicated post-processing workstation.

The HRCT scores were significantly higher in the BPD group compared to the other groups (p<0.001) and had highest numbers in subjects diagnosed with severe BPD. Most common HRCT changes were small peripheral opacities. Hypoattenuation during inspiration was only observed in the BPD group. Architectural distortion was observed in 6/24 BPD and 2/23 premature without BPD. HRCT scores correlated to FEV1 in a negative manner for preterm (p<0.001) and BPD (p<0.05) groups. Oxygen supplementation during the neonatal period correlated with HRCT score in a positive manner for preterm group (p<0.001). No differences in lung density were observed between the groups.

Young adults previously diagnosed with BPD have structural changes on CT which correlate with airway obstruction. Severity of BPD at the diagnosis was associated with CT abnormalities in adulthood. HRCT changes in adults with BPD were correlated with spirometry findings.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

NCT02923648

Funding Statement

The Swedish Heart-Lung Foundation, the Swedish Research Council, the King Oscar II Jubilee Foundation, Swedish Asthma and Allergy Foundation, Swedish Respiratory Society, Karolinska Institutet, Hesselman Foundation and through the Regional Agreement on Medical Training and Clinical Research (ALF) between Stockholm County Council and Karolinska Institutet. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

All participants provided written informed consent, and the study was approved by the Swedish Ethical Review Authority (ref: 2012/11872-31/4, ref: 2013/1416-32, ref 2017/868/-32) and from the Swedish Radiation Protection Committee (ref K2641-2012).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Data Availability

All data produced in the present study are available upon reasonable request to the authors

Abbreviations listBMIbody mass indexBPDBronchopulmonary dysplasiaDLCOadjdiffusion capacity of the lung for carbon monoxide adjusted for blood hemoglobin value percent predictedFfemaleFEV1Forced expiratory volume in 1 secondFVCforced vital capacityHRCT scorehigh-resolution computer tomography scoreHUHounsfield UnitsIQRinterquartile rangeLAV%lower attenuation valueLCIlung clearance indexLUNAPRE studyLung Obstruction in Adulthood of Prematurely Born studyMmaleRVresidual volume percent predictedTLCtotal lung capacity Liter