Effects of Pseudomonas aeruginosa colonization on lung function and anthropometric variables in children with cystic fibrosis

Abstract

The aim of this study was to evaluate how lung function and growth changed over time in children with cystic fibrosis (CF) colonized with pseudomonas aeruginosa (Pa) compared with those free of the organism. A total of 192 children attended our cystic fibrosis clinic between 1982 and 1992. Sixty-two of these had three or more annual assessments for lung function, and 117 had three or more annual assessments for height and weight. When lung function was expressed as a standard deviation score (SDS), forced expiratory volume in 1 second (FEV1) and forced expiratory flow at 25% of vital capacity (FEF25) decreased significantly more with respect to height in colonized compared with noncolonized children: FEV1, -0.052 verses -0.015 SDS/cm (P < 0.05); FEF25, -0.060 verses -0.007 SDS/cm (P < 0.05); forced vital capacity (FVC), -0.034 versus -0.012 (NS). In actual values those patients colonized with Pa increased their FEV1 by 16.4 versus 31.6 mL/cm (P < 0.01); FVC by 28.8 versus 41.4 mL/cm, P < 0.01; and FEF25 by -0.001 versus 0.015 L/s/cm, P < 0.01. In terms of height, colonized children grew at 5.63 versus 6.96 cm/yr, P < 0.001, and height SDS decreased in colonized compared with noncolonized children at -0.031 verses 0.08 SDS/yr, P < 0.05. Clinically, most children with CF, with or without Pa, grew within +/- 1 SD of the norm for weight and height. However, in terms of lung function despite optimum pulmonary management colonized children deteriorated significantly faster.

Acquisition ofPseudomonas aeruginosain Children With Cystic Fibrosis

“…Subsequently, Kerem et al 18 found that at 7 years of age, CF patients colonized with P aeruginosa had a significantly lower forced expiratory volume in 1 second compared with uninfected patients. Other data 19,20 also indicate a relationship between pulmonary dysfunction and pseudomonas-positive cultures. In addition, recent observations by McCubbin et al 21 have identified an association between pseudomonas infections and the development of bronchiectasis in young children with CF.…”

Pseudomonas aeruginosa In VitroPhenotypes Distinguish Cystic Fibrosis Infection Stages and Outcomes

“…The association between P. aeruginosa infection and measures of CF disease severity is clearly established, including increased rate of lung function decline, greater need for antibiotics and hospitalization, and decreased survival (2)(3)(4)(5)(6)(7)(8)(9)(10). Although there is a parallel between declining health and the progression from early to chronic P. aeruginosa, gaps remain in understanding the changes that P. aeruginosa undergoes during this critical transition period (11).…”

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

“…Chronic PA colonisation is associated with a lower FEV 1 in childhood , an accelerated rate of FEV 1 decline (Pamukcu et al, 1995;Kosorok et al, 2001;Emerson et al, 2002), a shorter median life expectancy (CFF Registry, 1996;Emerson et al, 2002) and much higher treatment costs (Baumann et al, 2003). Preventing this colonisation is considered the most important challenge for the CF clinician, as it frequently determines the patient's future quality of life and long-term survival (CF Trust 2002;Koch, 2002).…”