Pub Date : 2025-11-27DOI: 10.1016/s2213-2600(25)00372-8
Christopher William Course, Andrew Bush, Sailesh Kotecha
Preterm birth is increasingly recognised as a determinant of chronic respiratory disease across the life course. In this Series on prematurity-associated lung disease (PLD), we introduce the concept of PLD as a unifying framework for the diverse pulmonary consequences of preterm birth. Historically, most attention has focused on extremely preterm infants (<28 weeks of gestation) who develop bronchopulmonary dysplasia (BPD), yet not all infants with BPD have long-term morbidity. Conversely, those born very (28–31 weeks), moderate (32–33 weeks), or late (34–36 weeks) preterm also have increased risk for developing lung disease. Multiple factors beyond BPD—including gestational age and intrauterine growth restriction—contribute to PLD development. Recently described PLD phenotypes include prematurity-associated obstructive lung disease, prematurity-associated preserved ratio impaired spirometry, and prematurity-associated dysanapsis. Each phenotype reflects distinct early-life exposures and mechanisms, with differing implications for prognosis. Defining these phenotypes provides a foundation for personalised monitoring and targeted therapeutic strategies.
{"title":"Looking beyond bronchopulmonary dysplasia: prematurity-associated lung disease and its phenotypes","authors":"Christopher William Course, Andrew Bush, Sailesh Kotecha","doi":"10.1016/s2213-2600(25)00372-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00372-8","url":null,"abstract":"Preterm birth is increasingly recognised as a determinant of chronic respiratory disease across the life course. In this Series on prematurity-associated lung disease (PLD), we introduce the concept of PLD as a unifying framework for the diverse pulmonary consequences of preterm birth. Historically, most attention has focused on extremely preterm infants (<28 weeks of gestation) who develop bronchopulmonary dysplasia (BPD), yet not all infants with BPD have long-term morbidity. Conversely, those born very (28–31 weeks), moderate (32–33 weeks), or late (34–36 weeks) preterm also have increased risk for developing lung disease. Multiple factors beyond BPD—including gestational age and intrauterine growth restriction—contribute to PLD development. Recently described PLD phenotypes include prematurity-associated obstructive lung disease, prematurity-associated preserved ratio impaired spirometry, and prematurity-associated dysanapsis. Each phenotype reflects distinct early-life exposures and mechanisms, with differing implications for prognosis. Defining these phenotypes provides a foundation for personalised monitoring and targeted therapeutic strategies.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"94 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/s2213-2600(25)00369-8
Liesbeth Duijts, Petra Um Bergström, Sarah J Kotecha, Sailesh Kotecha, Mariëlle W Pijnenburg
Preterm birth has lifelong pulmonary consequences, with many individuals developing prematurity-associated lung disease (PLD). This third paper in the…
早产对肺部有终身影响，许多人会发展为早产相关肺病（PLD）。第三篇论文…
{"title":"Management of prematurity-associated lung disease from infancy through to adulthood","authors":"Liesbeth Duijts, Petra Um Bergström, Sarah J Kotecha, Sailesh Kotecha, Mariëlle W Pijnenburg","doi":"10.1016/s2213-2600(25)00369-8","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00369-8","url":null,"abstract":"Preterm birth has lifelong pulmonary consequences, with many individuals developing prematurity-associated lung disease (PLD). This third paper in the…","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"70 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/s2213-2600(25)00371-6
Cassidy Du Berry, Diane M Gray, Amber Bates, Darweeza Salaam-Geydien, Lex W Doyle, Shannon J Simpson
Preterm birth is increasingly recognised as adversely influencing lifelong lung function. This Series paper on prematurity-associated lung disease reviews studies reporting longitudinal lung function measurements in individuals who were born preterm. Evidence suggests that preterm birth alters lung function trajectories from early life onwards, with implications for future respiratory morbidity. We propose that this population needs rigorous follow up that should include systematic monitoring of lung function across the lifespan, starting in childhood. Key priorities include understanding risk factors for poor lung function trajectories and moving beyond bronchopulmonary dysplasia alone to establish the phenotype of individuals who were born preterm that are at increased risk of poor trajectory more precisely. Novel approaches, including data-driven analytics and large-scale collaborative studies, will be essential to define phenotypes and trajectories of prematurity-associated lung disease more robustly. Finally, we highlight the need for interventional studies to establish whether adverse lung function trajectories can be stabilised or improved, thereby reducing risk of early chronic obstructive pulmonary disease (ie, diagnosis at age <50 years).
{"title":"Trajectories of prematurity-associated lung disease: lifelong lung health","authors":"Cassidy Du Berry, Diane M Gray, Amber Bates, Darweeza Salaam-Geydien, Lex W Doyle, Shannon J Simpson","doi":"10.1016/s2213-2600(25)00371-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00371-6","url":null,"abstract":"Preterm birth is increasingly recognised as adversely influencing lifelong lung function. This Series paper on prematurity-associated lung disease reviews studies reporting longitudinal lung function measurements in individuals who were born preterm. Evidence suggests that preterm birth alters lung function trajectories from early life onwards, with implications for future respiratory morbidity. We propose that this population needs rigorous follow up that should include systematic monitoring of lung function across the lifespan, starting in childhood. Key priorities include understanding risk factors for poor lung function trajectories and moving beyond bronchopulmonary dysplasia alone to establish the phenotype of individuals who were born preterm that are at increased risk of poor trajectory more precisely. Novel approaches, including data-driven analytics and large-scale collaborative studies, will be essential to define phenotypes and trajectories of prematurity-associated lung disease more robustly. Finally, we highlight the need for interventional studies to establish whether adverse lung function trajectories can be stabilised or improved, thereby reducing risk of early chronic obstructive pulmonary disease (ie, diagnosis at age <50 years).","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"175 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/s2213-2600(25)00401-1
Eugenio De Corso, G Walter Canonica, Enrico Heffler
{"title":"EVEREST and the eosinophil paradox – Authors' reply","authors":"Eugenio De Corso, G Walter Canonica, Enrico Heffler","doi":"10.1016/s2213-2600(25)00401-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00401-1","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"27 1","pages":"e61"},"PeriodicalIF":76.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145600091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/s2213-2600(25)00362-5
Hnin W W Aung, Kristina Vermeersch, Hamish J C McAuley, Sanjay Ramakrishnan, Mustafa Abdo, Amber Beersaerts, Steven P Cass, Nicola Smallcombe, Iwein Gyselinck, Hendrik Pott, Tom J C Ward, Adam K A Wright, Christopher E Brightling, Pierre-Régis Burgel, Marco Contoli, Frits M E Franssen, Arturo Huerta, Jennifer K Quint, Bernd Schmeck, Lowie E G W Vanfleteren, Neil J Greening
Exacerbations punctuate the natural course of chronic obstructive pulmonary disease (COPD), posing a substantial burden on patients and health-care systems. Understanding the severity of an acute exacerbation of COPD (AECOPD) is crucial for stratifying mortality risk and guiding treatment decisions. Currently, the severity of an AECOPD is primarily graded on outcomes of health-care use. Given the complex heterogeneity in pathogenesis, clinical presentation, post-event trajectory, and patient perspectives, this approach does not adequately address the causes and extent of clinical deterioration or consider an individual's baseline status, upon which implementation of treatment and prevention of future exacerbations rely. We have conceptualised a multidimensional model to stratify the severity and prognostic risk of an AECOPD, incorporating three distinct domains: baseline functional status (B), the intensity of the event (acuity; A), and the causal trigger (t). The BAt classification for AECOPD could allow for more individualised prognostic and therapeutic implications. The validation process for this model is underway, with preliminary findings supporting its feasibility.
{"title":"Multidimensional prognostic risk stratification of COPD exacerbations: the baseline, acuity, and trigger (BAt) model","authors":"Hnin W W Aung, Kristina Vermeersch, Hamish J C McAuley, Sanjay Ramakrishnan, Mustafa Abdo, Amber Beersaerts, Steven P Cass, Nicola Smallcombe, Iwein Gyselinck, Hendrik Pott, Tom J C Ward, Adam K A Wright, Christopher E Brightling, Pierre-Régis Burgel, Marco Contoli, Frits M E Franssen, Arturo Huerta, Jennifer K Quint, Bernd Schmeck, Lowie E G W Vanfleteren, Neil J Greening","doi":"10.1016/s2213-2600(25)00362-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00362-5","url":null,"abstract":"Exacerbations punctuate the natural course of chronic obstructive pulmonary disease (COPD), posing a substantial burden on patients and health-care systems. Understanding the severity of an acute exacerbation of COPD (AECOPD) is crucial for stratifying mortality risk and guiding treatment decisions. Currently, the severity of an AECOPD is primarily graded on outcomes of health-care use. Given the complex heterogeneity in pathogenesis, clinical presentation, post-event trajectory, and patient perspectives, this approach does not adequately address the causes and extent of clinical deterioration or consider an individual's baseline status, upon which implementation of treatment and prevention of future exacerbations rely. We have conceptualised a multidimensional model to stratify the severity and prognostic risk of an AECOPD, incorporating three distinct domains: baseline functional status (B), the intensity of the event (acuity; A), and the causal trigger (t). The BAt classification for AECOPD could allow for more individualised prognostic and therapeutic implications. The validation process for this model is underway, with preliminary findings supporting its feasibility.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"5 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145600090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/s2213-2600(25)00392-3
Arzu Yorgancioğlu
{"title":"A call to action: environmental and climate impacts on asthma","authors":"Arzu Yorgancioğlu","doi":"10.1016/s2213-2600(25)00392-3","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00392-3","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"30 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145560172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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