University of Oulu

Pulakka A, Risnes K, Metsälä J, et al. Preterm birth and asthma and COPD in adulthood: a nationwide register study from two Nordic countries. Eur Respir J 2023; 61: 2201763,

Preterm birth and asthma and COPD in adulthood : a nationwide register study from two Nordic countries

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Author: Pulakka, Anna1,2; Risnes, Kari3,4; Metsälä, Johanna1;
Organizations: 1Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
2Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
3Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
4Children’s Clinic, St. Olavs University Hospital, Trondheim, Norway. 5 Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
5Center for Health Care Improvement, St. Olavs University Hospital, Trondheim, Norway
6Faculty of Medicine, and Health Technology, Tampere Center for Child, Adolescent, and Maternal Health Research: Global Health Group, Tampere University, Tampere, Finland
7PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
8Finnish Social and Health Data Permit Authority Findata, Helsinki, Finland
9Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
10Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
11Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
12Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: European Respiratory Society, 2023
Publish Date: 2023-10-03


Background: Preterm birth affects lungs in several ways but few studies have follow-up until adulthood. We investigated the association of the entire spectrum of gestational ages with specialist care episodes for obstructive airway disease (asthma and chronic obstructive pulmonary disease (COPD)) at age 18–50 years.

Methods: We used nationwide registry data on 706 717 people born 1987–1998 in Finland (4.8% preterm) and 1 669 528 born 1967–1999 in Norway (5.0% preterm). Care episodes of asthma and COPD were obtained from specialised healthcare registers, available in Finland for 2005–2016 and in Norway for 2008–2017. We used logistic regression to estimate odds ratios (ORs) for having a care episode with either disease outcome.

Results: Odds of any obstructive airway disease in adulthood for those born at <28 or 28–31 completed weeks were 2–3-fold of those born full term (39–41 completed weeks), persisting after adjustments. For individuals born at 32–33, 34–36 or 37–38 weeks, the odds were 1.1- to 1.5-fold. Associations were similar in the Finnish and the Norwegian data and among people aged 18–29 and 30–50 years. For COPD at age 30–50 years, the OR was 7.44 (95% CI 3.49–15.85) for those born at <28 weeks, 3.18 (95% CI 2.23–4.54) for those born at 28–31 weeks and 2.32 (95% CI 1.72–3.12) for those born at 32–33 weeks. Bronchopulmonary dysplasia in infancy increased the odds further for those born at <28 and 28–31 weeks.

Conclusion: Preterm birth is a risk factor for asthma and COPD in adulthood. The high odds of COPD call for diagnostic vigilance when adults born very preterm present with respiratory symptoms.

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Series: European respiratory journal
ISSN: 0903-1936
ISSN-E: 1399-3003
ISSN-L: 0903-1936
Volume: 61
Issue: 6
Article number: 2201763
DOI: 10.1183/13993003.01763-2022
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 733280 for RECAP. Funding also comes from the NORFACE Joint Research Programme on Dynamics of Inequality Across the Life-course, which is co-funded by the European Commission through Horizon 2020 under grant agreement number 724363, Academy of Finland (315690), European Union Horizon 2020 (874739, LongITools), the European Union Horizon Europe (101057739, TRIGGER), Sigrid Juselius Foundation, Foundation for Pediatric Research, Finnish Foundation for Cardiovascular Research, Diabetes Research Foundation, Novo Nordisk Foundation, Finska Läkaresällskapet, Yrjö Jahnsson Foundation, the joint research committee (FFU) between St. Olavs Hospital HF and the Faculty of Medicine NTNU (30223-2021) and the Norwegian Research Council (295989).
EU Grant Number: (874739) LONGITOOLS - Dynamic longitudinal exposome trajectories in cardiovascular and metabolic non-communicable diseases
Copyright information: © The authors 2023. This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact