Abstract
IntroductionPreterm birth is associated with increased risk of asthma-like symptoms and purchase of prescription asthma medication in childhood. We investigated whether this association persists into adulthood and whether it is affected by accounting for neonatal respiratory morbidity (acute respiratory disease and bronchopulmonary dysplasia).MethodsA national cohort of all infants born in Denmark in the period 1980–2009 was included in this register study. Data on purchase of asthma medication (combination of inhaled β-2 agonists and other drugs for obstructive airway disease) in 2010–2011 were obtained from the Danish National Prescription Registry. Associations between gestational age (GA), neonatal respiratory morbidity and a cross-sectional evaluation of asthma medication purchase were explored by multivariate logistic regressions.ResultsA full dataset was obtained on 1,790,241 individuals, 84.6% of all infants born in the period. Odds-ratios (95% CI) for the association between GA and purchase of asthma medication during infancy were: 3.86 (2.46–6.04) in GA 23–27 weeks, 2.37 (1.84–3.04) in GA 28–31 weeks and 1.59 (1.43–1.77) in GA 32–36 weeks compared to term infants with GA 37–42 weeks. Associations weakened in older age groups and became insignificant in young adults born extremely and very preterm with odds-ratios: 1.41 (0.63–3.19) and 1.15 (0.83–1.60) in GA 23–27 and 28–31 respectively. When adjusting for neonatal respiratory morbidity, the associations weakened but persisted both in childhood and adolescence.ConclusionThere was a strong dose-response association between gestational age and the purchase of prescription asthma medication in infancy and childhood. This association weakened during adolescence and was mostly non-significant in young adulthood. The increased risk of prescription asthma medication purchase in ex-preterm children could only partly be explained by neonatal respiratory morbidity.
Highlights
Preterm birth is associated with increased risk of asthma-like symptoms and purchase of prescription asthma medication in childhood
We investigated whether this association persists into adulthood and whether it is affected by accounting for neonatal respiratory morbidity
A Swedish register based study from 2011 found that the whole spectrum of prematurity is a risk factor for purchase of asthma controller medication during childhood and adolescence [8]. Since both bronchodilators and asthma controller medications are often prescribed to non-specific respiratory symptoms in infants and children, it is uncertain whether these symptoms should be expected to persist in adulthood. Another recent Swedish register based study found a significant increase in the purchase of prescription asthma medication in young adults born extremely preterm (GA under 28 weeks) but no increase in those born at gestational age (GA) 28–36 weeks compared to adults born at term, which suggests an outgrowing of the problem for the moderately preterm [9]
Summary
Preterm birth is associated with increased risk of asthma-like symptoms and purchase of prescription asthma medication in childhood. A Swedish register based study from 2011 found that the whole spectrum of prematurity is a risk factor for purchase of asthma controller medication during childhood and adolescence [8] Since both bronchodilators and asthma controller medications are often prescribed to non-specific respiratory symptoms in infants and children, it is uncertain whether these symptoms should be expected to persist in adulthood. Another recent Swedish register based study found a significant increase in the purchase of prescription asthma medication in young adults born extremely preterm (GA under 28 weeks) but no increase in those born at GA 28–36 weeks compared to adults born at term, which suggests an outgrowing of the problem for the moderately preterm [9]. No other studies have explored the effects of the entire spectrum of prematurity on respiratory symptoms and purchase of asthma medication in adulthood
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