Looking Back, to Look Forward

In an attempt to tidy up my home office I had to put away a few “volumes”, yes volumes of medical information, I came across the section from my preemie days. As a preemie kid who always seemed to be ill or having some sort of complex medical situation, I gained a bit resilience. At one time, I was on a mad hunt for connections to my phenotype of asthma by looking back at a ton of medical records. I have had a few physicians who have been curious about the link of premature birth, to my development severe asthma. I have been curious if this was something that was always written in the cards for me. Was I always destined to have severe asthma? One thing that I found out much later in life, is that the physical size of my lungs was quite small. Essentially, child-sized lungs, in an adult body. It is my understanding that while this may have some effect on my breathing mechanics, it is not well understood to what extent. There is some thought that my lungs just learned to adapt and compensate for their small size.

Impact of fetal and post-natal exposures on asthma

The theory is that respiratory disease “may” begin in early life with adverse exposures in fetal and postnatal life, this may possibly influence lung growth and development which could be related to smaller airways and lung function.1 Researchers think this may lead to a predisposition for asthma and COPD in childhood.2-4 Research has shown that “catch up” growth has been linked to an increase in asthma-related outcomes. Preemie lungs are not fully developed and are at risk for suboptimal further development.5 You may know that I am a sucker for research and discovering new things, I learned that those born before 28 weeks may have suboptimal lung development and lower pulmonary function and an increased risk of childhood asthma. I dug into a bit on my own and discovered papers highlighting that those born before 28 weeks were found to have lower lung volumes and and reduced airway caliber in adulthood.6-7 Considering that I was an itty bitty 26-weeker, I fall right in to this category. The discovery that I found the most exciting, is the linkage between children that were born preterm have been noted to have higher chemokine and cytokines levels in nasopharyngeal aspirates, which researchers have suggested is linked to pro-inflammatory stimuli.8 I like to think that this explains a lot of what I have developed. I seem to be so full of inflammation responsiveness which links my Th2 responses and my response to anti-inflammatories, in particular, being prednisone dependent. My respirologist tends to agree, however, the exact linkages are still being determined.

This reminds me, I should probably follow up on where the research fellow who was tasked with the investigation of my preemie lungs is with answers or hypothesis. Their investigations, were primarily related to the ability to quantify the outcome of suboptimal lung development via MRI.

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