RHiNO has moved from describing respiratory symptoms and reduced lung function to identifying prematurity-associated lung disease (PLD), distinct physiological phenotypes, treatment responses, mechanisms and lifelong respiratory trajectories.
Together, RHiNO studies show that respiratory disease after preterm birth is heterogeneous, biologically complex and potentially modifiable. The findings provide a basis for more precise diagnosis, follow-up and intervention.
Children born preterm have an increased risk of respiratory symptoms and lower expiratory airflow at school age. These abnormalities are not confined to children born extremely preterm or those diagnosed with BPD as neonates.
Bronchopulmonary dysplasia remains important, but later lung function reflects multiple developmental influences including gestational age, fetal growth and postnatal exposures. Abnormal physiology can occur even in children without neonatal BPD.
RHiNO helped characterise POLD, pPRISm and pDysanapsis, alongside a preterm control pattern. These phenotypes are defined using routinely measured spirometry and show that PLD is not one uniform disease.
Bronchodilator testing demonstrates that a substantial proportion of abnormal pre-bronchodilator spirometry can move into the preterm-control range after treatment, but the degree of reversibility differs according to physiological phenotype.
The RHiNO randomised clinical trial showed clinically important improvement in lung function with combined inhaled corticosteroid/long-acting β2-agonist therapy in selected preterm-born children with reduced lung function.
Exercise studies show abnormalities in cardiorespiratory performance after preterm birth, including differences in ventilatory and physiological responses that are not fully captured by a resting spirometry measurement.
Hyperpolarised-gas MRI and complementary physiological techniques can identify regional abnormalities of ventilation and gas exchange in preterm-born children that may be missed by conventional global lung-function measurements.
RHiNO research into ambient air pollution highlights the importance of potentially modifiable postnatal exposures acting on lungs whose development was already altered by preterm birth.
Metabolomic and mechanistic studies identify disturbances in pathways related to oxidative stress, energy metabolism and airway biology. Some abnormalities seen in POLD resemble those reported in adult COPD.
RHiNO is increasingly studying how PLD phenotypes and lung function change through adolescence and towards adulthood. Some physiological patterns appear more stable than others, while some individuals transition between phenotypes as their lungs grow.
The concept of prematurity-associated lung disease moves beyond a single neonatal label and asks what physiological pattern an individual has later in life.
In January 2026, a three-paper Series brought together the emerging PLD framework across the life course: its phenotypes, respiratory trajectories and management from infancy to adulthood.
Defining the physiological framework and moving beyond BPD alone.
Understanding how respiratory impairment evolves from childhood into adult life.
Bringing together assessment, treatment and prevention from infancy through adulthood.
Identify physiological abnormality rather than relying on symptoms or neonatal history alone.
Match therapy more closely to reversibility and physiological phenotype.
Focus surveillance on children and young adults whose lung-function trajectories appear most vulnerable.
Ultimately test whether earlier intervention can preserve lung growth and reduce later chronic respiratory disease.
The next phase of RHiNO is increasingly longitudinal. Current analyses ask how stable PLD phenotypes are, which abnormalities respond to bronchodilator treatment, how genetic susceptibility influences PLD, and whether childhood physiological patterns predict later respiratory health.
RHiNO is increasingly asking not only whether lung function is abnormal, but which phenotype an individual has, why it developed, whether it changes with growth, and whether its trajectory can be modified.