Use of computerized tomography and chest X‐rays in evaluating efficacy of aerosolized recombinant human DNase in cystic fibrosis patients younger than age 5 years: A preliminary study*

Abstract

The aim of this study was to evaluate the ability of high-resolution computerized tomography (HRCT) of the chest and chest x-rays (CXR) to determine efficacy of inhaled recombinant human DNase (rhDNase) in cystic fibrosis (CF) patients younger than 5 years of age. A randomized, double-blind, placebo-controlled pilot study of 12 patients with CF younger than 5 years of age, attending the University of Michigan Cystic Fibrosis Center (Ann Arbor, MI) was conducted. The changes in the HRCT and CXR score from baseline to day 100 of therapy were assessed using a previously validated scoring system. The mean changes of HRCT scores between the rhDNase and placebo groups were found to be significant at the 95% level, with mean change +/- SE mean of - 1.00 +/- 0.53 and 0.58 +/- 0.24 for rhDNase and placebo groups, respectively (P = 0.02). The difference in CXR score was not significant between the two groups. An analysis was performed to relate HRCT subscores to CXR score; only thickening of the intra-interlobular septae was significantly correlated with the total CXR score (r = - 0.7, P < 0.01). There was improvement in the parents' assessments of the patients' well-being, with improvement in physical activity, decreased cough, sleep quality, and appetite in those subjects receiving rhDNase. We conclude that the administration of rhDNase was associated with improvement in the HRCT scan in CF patients younger than 5 years of age. Findings indicate that HRCT of the chest is useful and sensitive in studying responses to therapy in patients with CF lung disease. To our knowledge, this is the first report of the use of HRCT to assess the effectiveness of a therapeutic modality in so young a CF patient population.

Nebulized 3% Hypertonic Saline Solution Treatment in Hospitalized Infants With Viral Bronchiolitis*

“…Anteroposterior and lateral chest radiographs were obtained at the time of hospital admission and 3 days afterwards. The radiograph assessment score described by Nasr et al 19,30 was utilized.…”

Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis

“…[75][76][77][78][79][80][81] Dornase alfa has been shown to have positive effects on CT changes and LCI [82][83][84] and improved health-related quality-of-life scores in children >6 years. 85 Safety and tolerability of dornase alfa has been demonstrated in children ages 3 months to 5 years.…”

Computed tomographic imaging of the airways: relationship to structure and function

“…This is not an unexpected result, since HRCT can detect regional abnormalities such as small areas of atelectasis and bronchiectasis that may be functionally silent. A few, small clinical trials have been performed using HRCT score as an end-point, some of which failed to demonstrate a significant treatment effect; however, the time period between repeat scans was short [132,137,140,153,154].…”