Physician’s WeeklyPrematurity-Associated Lung Disease Requires Follow-Up Beyond Early Childhood

⚠️ Review Article / Expert Opinion

Respiratory surveillance after preterm birth often declines once children leave neonatal follow-up programs, despite ongoing lung development throughout childhood and adolescence. A review published in Expert Review of Respiratory Medicine proposes a broader framework of prematurity-associated lung disease (PLD), emphasizing that respiratory morbidity after preterm birth extends beyond traditional definitions of bronchopulmonary dysplasia (BPD). The authors argue that clinicians should assess present-day symptoms and objective lung function rather than relying solely on neonatal diagnoses when evaluating respiratory complaints in children born preterm.

Clinical Considerations

• BPD remains an important marker of future respiratory risk but does not identify all children who may later develop respiratory symptoms, exercise limitation, or abnormal pulmonary function.
• Children born prematurely may experience wheeze, exertional dyspnea, recurrent respiratory infections, chronic cough, reduced exercise tolerance, or impaired lung function even without a history of significant BPD.
• Gestational age itself appears to be an important predictor of later pulmonary outcomes, including among moderately and late-preterm children.
• Spirometry may identify distinct physiologic patterns including prematurity-associated obstructive lung disease, preserved ratio impaired spirometry, and dysanaptic lung growth rather than a single asthma phenotype.
• Wheezing and airflow limitation after preterm birth may resemble asthma but may arise from different underlying mechanisms and may not demonstrate typical reversibility patterns.
• Early-life alterations in lung development may contribute to COPD-like airflow limitation later in adulthood, making prematurity an important component of a lifelong respiratory history.

Practice Applications

• Ask about prematurity history when evaluating unexplained respiratory symptoms, exercise limitation, recurrent respiratory illnesses, or frequent inhaler use.
• Use age-appropriate lung-function testing, including spirometry and bronchodilator assessment when feasible, to characterize respiratory phenotypes.
• Avoid automatically labeling wheezing as asthma without considering prematurity-associated lung disease in the differential diagnosis.
• Track longitudinal lung-function trajectories rather than relying exclusively on NICU diagnoses or historical BPD status.
• Consider specialty referral for children born preterm who develop persistent symptoms, impaired exercise tolerance, or abnormal pulmonary-function testing.