| Summary: | The long term pulmonary consequences of prematurity are of increasing importance as more neonates with chronic lung disease, in particular those who developed bronchopulmonary dysplasia (BPD) survive to adulthood (Eber and Zach, 2001). There is growing concern that lung injury in early life may be associated with the premature development of chronic obstructive pulmonary disease (COPD). The nature and extent of lung impairment in adults surviving BPD has not been well studied. The aim of this thesis was to test the hypothesis that adult survivors of BPD have evidence of greater lung function impairment, reduced exercise capacity, evidence of structural lung abnormalities and persisting airways inflammation compared to two age/gender matched reference groups, one to control for premature birth and the other comprising individuals born healthy at term. Subjects underwent full lung function testing, high resolution chest HRCT scans and performed symptom limited cardiopulmonary stress tests (CPEST). BPD subjects reported significantly more respiratory symptoms when compared to term controls. BPD subjects had significant lung function impairment (lower FEV1, FEV1/ FVC ratio and FEF25-75% predicted), compared with both control groups. In the majority (87%) of BPD subjects with airflow obstruction the impairment was fixed. Lung volume measurements were more impaired in BPD subjects consistent with air trapping. BPD subjects had evidence of significantly lower diffusing capacity than both control groups. LCI scores were significantly more impaired in BPD subjects compared to term controls. All BPD subjects had evidence of significant radiological abnormalities on HRCT scans. The severity of radiological abnormality was strongly and significantly correlated with lung function impairment but not exercise capacity. Exercise capacity was significantly lower in BPD subjects compared with term controls, when corrected for general activity levels. Gestational age and birthweight were significant predictors of lung function impairment and radiological abnormalities in adult life. The studies detailed in this thesis confirm that lung function impairment in survivors of BPD persists into adult life. A large proportion of survivors have lung function in the abnormally low range with fixed airflow obstruction. These findings combined with the presence of structural lung abnormalities with evidence of reduced exercise capacity, suggest clinically important impairment in respiratory health persists in adult survivors of BPD
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