Early Respiratory Infection Is Associated with Reduced Spirometry in Children with Cystic Fibrosis

Abstract

The onset of lung disease in infancy, specifically the occurrence of lower respiratory tract infection, is associated with low lung function in young children with cystic fibrosis. Deficits in lung function measured in infancy persist into childhood, emphasizing the need for targeted therapeutic interventions in infancy to maximize functional outcomes later in life.

Early Childhood Risk Factors for Decreased FEV1at Age 6-7 Years in Young Children with Cystic Fibrosis

“…Previous analyses have also described associations between FEV 1 % predicted at age 6 years and the presence of respiratory signs or symptoms (e.g., daily cough or crackles or wheeze on auscultation), the frequency of oral antibiotics, and the frequency of pulmonary exacerbations treated with intravenous antibiotics (4,5,8,39). In our study, the presence of crackles or wheeze on auscultation in the year of enrollment (6). Neither the frequency of treatment with oral or inhaled antibiotics in the enrollment year, or between enrollment and age 6 years, was associated with FEV 1 % predicted in our study.…”

“…Several studies have demonstrated that young age at initial P. aeruginosa acquisition is an important risk factor for the development of more severe CF lung disease (6,(31)(32)(33). It is likely that the earlier acquisition of P. aeruginosa allows more time for phenotypes to develop that are associated with pulmonary exacerbations and/or lower FEV 1 % predicted, for example, mucoidy (34,35).…”

“…The ability to identify risk factors for low FEV 1 % predicted (FEV 1 expressed as a percentage of the predicted normal value) at age 6 could provide opportunities to intervene and slow the progression of CF lung disease. Previous studies have identified risk factors for low FEV 1 % predicted at age 6, including female sex, poor nutritional status, viral infections, persistent infection with Pseudomonas aeruginosa (P. aeruginosa), respiratory symptoms, pulmonary exacerbations, and low socioeconomic status (3)(4)(5)(6)(7)(8). It is unclear whether these risk factors remain applicable in the current era, as children with CF born today are more likely to be detected by newborn screening (NBS) and treated more aggressively with antibiotics and CF-specific therapies, and to undergo eradication therapy when P. aeruginosa is isolated from respiratory cultures (9)(10)(11).…”

Early lung surveillance of cystic fibrosis: what have we learnt?

“…Data from AREST CF suggest that FEV measured in infants with CF is reduced compared to healthy infants and declines with neutrophilic inflammation in BAL and P. aeruginosa and S. aureus infection [23]. A recent longitudinal study further showed that infection with P. aeruginosa and S. aureus as well as other bacterial pathogens that elicit a pro-inflammatory response, such as H. influenza and Aspergillus species during infancy, was associated with lower lung function compared with uninfected infants with CF with this diminished lung function persisting into school age [24]. Collectively, these data support the use of both FEV and LCI in infancy to identify CF infants at risk of poorer outcomes and therefore benefit from treatment intensification.…”

Le microbiome pulmonaire en 2015

“…La diversité de la communauté bactérienne est en effet diminuée chez les patients plus âgés chez lesquels la famille Pseudomonadaceae prédo-mine [15]. L'infection chronique par P. aeruginosa, qui est considéré comme le pathogène le plus fréquemment rencontré chez les patients atteints de mucoviscidose, est associée à la diminution de la fonction pulmonaire [7,26]. À côté de P. aeruginosa, d'autres espèces ou genres (Streptococcus, Prevotella, Veillonella, Rothia, Actinomyces, Gemella, Granulicatella, Fusobacterium, Neisseria, Atopobium, etc.)…”