Effect of Bronchodilators on Forced Expiratory Volume in 1 s in Preterm-Born Participants Aged 5 and Over: A Systematic Review

Abstract

Background and Objectives: Preterm-born participants are at risk of long-term deficits in percentage predicted forced expiratory volume in 1 s (%FEV₁). Since it is unclear if these deficits respond to bronchodilators, we systematically reviewed the evidence for reversibility of deficits in %FEV₁ by bronchodilators in preterm-born participants. Design: Studies reporting a change in %FEV₁ in response to bronchodilator treatment in preterm-born participants at ≥5 years of age, with or without a term-born control group, were identified. The quality of studies was assessed by adapted tools. Due to considerable heterogeneity between studies, formal meta-analysis was not possible. Results: From 8,839 titles, 22 studies were identified after an updated search in May 2013. Twenty-one studies assessed the response to a single inhaled dose of a bronchodilator, and 1 study assessed longer-term effects. Most studies observed decreased %FEV₁ in preterm-born participants compared with controls. Most studies observed improved %FEV₁ after a single dose of bronchodilator, with the largest improvements noted in those with bronchopulmonary dysplasia, who had greater deficits of %FEV₁ when compared with preterm and term controls. One long-term study investigated a 2-week terbutaline administration, but the initial FEV₁ after a single dose did not show a change in %FEV₁ of ≥15%, but 5/29 (17%) children had an increased %FEV₁ of ≥10%. Conclusions: In this systematic review, disparate studies were identified. Although single doses of bronchodilators appear to improve the FEV₁ in the short term, further studies are required to assess their longer-term benefits not only on airway obstruction, but also their effect on respiratory symptoms.