Prematurity is a risk factor for impaired lung function. We sought to assess the long-term effect of palivizumab immunization and extreme prematurity (<29 weeks) on respiratory symptoms and pulmonary function at adolescence.We examined survivors of extreme prematurity (<29 weeks) at 13-18 years of age (study group, SG). SG babies born immediately prior to palivizumab immunization (non-palivizumab group, NPG) were compared to those born just after implementation (PG), as well as to a control group (CG). For SG patients, lung function at adolescence was further compared longitudinally to that at primary school age.Sixty-four adolescents aged 15.76 ±1.52 years, mean ±SD, were included: 46 SG (17 PG and 29 NPG) and 18 CG. For the SG, wheezing episodes, inhaler use and hospitalizations were uncommon. For the SG compared to the CG, FEV1% predicted was 82.60% ±13.54 vs. 105.83% ±13.12, mean ±SD, p <0.001, and LCI was 7.67 ±1.02 vs. 7.46 ±0.70, p=0.48, respectively. SG adolescents with BPD had a higher LCI than non-BPD (7.94±1.11 vs 7.20±0.60, p=0.002). PG and NPG adolescents were not significantly different. Comparing SG in adolescence to primary school age, we found improvement in mean FEV1% predicted bronchodilator response (0.37%±9.98 vs 5.67%±9.87, p=0.036) and mean PC20 (12.16±4.71 mg/ml vs 4.14±4.51 mg/ml, respectively, p<0.001).Palivizumab did not provide any discernable long-term protective effect. Nevertheless, adolescent survivors of extreme prematurity showed good clinical and physiological outcomes, except for mildly raised LCI in BPD subjects. Airway hyper reactivity detected at primary school age, decreased by adolescence.