Young adults in their early 20s who were born prematurely have lungs that are similar to those of a healthy older person or casual smoker.

New research released this week shows that premature infants, born less than 28 weeks of age, are at increased risk for contracting bronchopulmonary dysplasia, a chronic respiratory condition.

The condition is particularly acute for those who receive oxygen therapy to help them breathe. The higher levels of oxygen, as well as the increased pressure from the ventilator, results in more tissue scarring in the lungs.

For a new study, University of Oregon researchers compared the lung function of adults born after fewer than 32 weeks to adults born full term.

Previous research has indicated that infants with BPD are at a higher risk for chronic obstructive pulmonary disease, a degenerative condition that makes it difficult to breathe.

COPD affects 329 million people worldwide—and is most often a consequence of smoking or exposure to air pollution. It is the third-leading cause of death worldwide.

Researchers looked at three distinct groups: 20 adults born prematurely with BPD, 15 adults born prematurely without BPD, and a control group of 20 healthy adults born full-term. The subjects were put through a series of tests designed to examine lung function during exercise.

The study, which was published in the Annals of the American Thoracic Society, indicates that adults born prematurely without BPD, like their counterparts with it, show symptoms of a mild form of COPD by their mid-20s.

“We were expecting more variation between the two preterm groups—with and without BPD,” says Andrew T. Lovering, a professor at the University of Oregon. “We didn’t anticipate that they would share a similar lung profile.”

Even if the subjects experience a normal rate of respiratory decline throughout their lives, adult preterm survivors with COPD will likely develop respiratory complications at a much younger age, Lovering says. A more rapid decline leads to fatigue and poor exercise capacity.

There is currently no effective way of caring for adult preterm survivors as they enter adulthood, he says.

Further, very few if any respiratory physicians routinely inquire about the neonatal period when treating their patients. This means the patients are often misdiagnosed as asthmatic, while the underlying cause is different.

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