Characterising airway obstructive, dysanaptic and PRISm phenotypes of prematurity-associated lung disease. 2023

Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
Department of Child Health, Cardiff University School of Medicine, Cardiff, UK.

Although obstructive airway disease has been shown to be associated with prematurity, other spirometry phenotypes are less well described. We characterised abnormal spirometry phenotypes in preterm-born children, including prematurity-associated obstructive lung disease (POLD, forced expiratory volume in 1 s (FEV1)<lower limit of normal (LLN), FEV1/forced vital capacity (FVC)<LLN), prematurity-associated preserved ratio of impaired spirometry (pPRISm, FEV1<LLN, FEV1/FVC≥LLN) and prematurity-associated dysanapsis (pDysanapsis, FEV1≥LLN, FEV1/FVC<LLN), and associated them with early life factors, bronchodilator responsiveness and fractional exhaled nitric oxide (FENO). 768 children, aged 7-12 years, underwent FENO measurements and spirometry before and after salbutamol. Groups were compared using parametric tests; multinomial regression was used. 22.6% of 544 preterm-born (mean gestation: 31 weeks) and 9.2% of 195 term-born children, with satisfactory data available, were classified into one of four abnormal spirometry groups. Each phenotype was generally more prevalent in preterm-born children than in the term-born children. For the preterm group, POLD-reversible (4.4%) was associated with increased FENO, bronchopulmonary dysplasia (BPD) and intrauterine growth restriction. POLD-fixed group (3.3%) did not have increased FENO but was associated with BPD. 41% of the pDysanapsis group (5.9%) had bronchodilator response, 31% had increased FENO and was associated with postnatal weight gain. In the pPRISm group (9%), 13% responded to bronchodilators, FENO was not increased and was non-significantly associated with body mass index (p=0.064). Further to airway obstruction, we describe airway dysanapsis and pPRISm spirometry phenotypes in survivors of prematurity, both of which have poor outlook in other disease groups. By identifying specific phenotypes, targeted therapy can be developed to improve long-term outcomes.

UI MeSH Term Description Entries

Related Publications

Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
November 2025, The Lancet. Respiratory medicine,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
October 2008, The clinical respiratory journal,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
February 2015, The Journal of pediatrics,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
January 2014, The clinical respiratory journal,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
June 2002, Paediatric respiratory reviews,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
August 2019, Current HIV/AIDS reports,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
August 2006, Proceedings of the American Thoracic Society,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
November 2016, Cells,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
November 2025, The Lancet. Respiratory medicine,
Michael Cousins, and Kylie Hart, and Sarah J Kotecha, and A John Henderson, and W John Watkins, and Andrew Bush, and Sailesh Kotecha
February 1991, Transplantation proceedings,
Copied contents to your clipboard!