A16-01 The Respiratory Effects Of Prematurity Extend Over The Lifespan: Analyses From The SPIROMICS And SOURCE Studies

Rationale Premature birth (prematurity) is known to impact lung function throughout childhood, but the natural history of preterm lung disease into adulthood is less well characterized. As those born prematurely transition into adulthood, there are gaps in published lung function progression, and limited data on emerging radiographic patterns of structural lung disease. Using two complementary cohorts of adults at-risk for or with COPD, we assessed associations between prematurity and respiratory outcomes, including spirometry, Chest CT, and symptom measures. Methods Excluding never-smoker controls, we evaluated baseline data from the SOURCE (younger individuals largely at-risk for COPD; ≥10 pack-years) and SPIROMICS (older adults; ≥20 pack-years) cohorts. In both, prematurity was established by self-report, which was assessed in SOURCE dichotomously (<37 weeks, yes/no), while SPIROMICS distinguished early (<33 weeks) vs. late pre-term (33-36 weeks). We evaluated associations between prematurity and physiologic, radiographic, and patient-reported respiratory outcomes using linear regression models accounting for demographics, education, tobacco exposure (current use, pack-years, and secondhand smoke), BMI and scanner model (for CT outcomes only). Sensitivity analyses adjusted for occupation and 10-year PM2.5 exposure when available in SPIROMICS. Results SOURCE (n = 610; mean age at enrollment: 46.6y) and SPIROMICS (n = 2117, mean age at enrollment: 63.9y) included 6.7% and 3.5% subjects born prematurely (<37 weeks), respectively. In both cohorts, individuals born prematurely had lower spirometry measures (both FEV1 and FVC), though more prominently in individuals born early preterm in the older SPIROMICS cohort (figure). In SPIROMICS, prematurity was associated with increased CT measures of air trapping (DPMGasTrapping: β 16.5%, P < 0.001; PRMfSAD: β 8.4%; P = 0.009) and airway wall thickness (Pi10: β 0.04; P=.049), whereas no associations with CT outcomes were observed in SOURCE. Results were unchanged in sensitivity analyses. In both cohorts, individuals born prematurely had greater symptom burden, with increased Chronic Airways Assessment Test scores in SOURCE (β 2.2%; P = 0.049) and increased St. George’s Respiratory Questionnaire scores (β 9.5%; P = 0.017) and lower six-minute walk distance (—45.8; P = 0.034) in SPIROMICS. Conclusions In cohorts of individuals with significant smoking history, prematurity has long-term consequences for respiratory health that extend into adulthood. Through multifaceted respiratory assessments, our study demonstrates evidence of physiologic and radiographic sequelae persisting across the lifespan, with more significant decrements appreciated in those born prematurely. Further work is needed to determine if more contemporary birth cohorts continue to have persistent impairments in respiratory function and health and to define interventions to improve early lung disease detection to alter long-term trajectories.