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Ren CL, Slaven JE, Haas DM, Haneline LS, Tiller C, Hogg G, Bjerregaard J, Tepper RS. Forced expiratory flows and diffusion capacity in infants born from mothers with pre-eclampsia. Pediatr Pulmonol 2022; 57:2481-2490. [PMID: 35796049 PMCID: PMC9489632 DOI: 10.1002/ppul.26064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 01/01/2023]
Abstract
RATIONALE Animal models suggest pre-eclampsia (Pre-E) affects alveolar development, but data from humans are lacking. OBJECTIVE Assess the impact of Pre-E on airway function, diffusion capacity, and respiratory morbidity in preterm and term infants born from mothers with Pre-E. METHODS Infants born from mothers with and without Pre-E were recruited for this study; term and preterm infants were included in both cohorts. Respiratory morbidity in the first 12 months of life was assessed through monthly phone surveys. Raised volume rapid thoracoabdominal compression and measurement of diffusion capacity of the lung to carbon monoxide (DLCO) were performed at 6 months corrected age. MEASUREMENTS AND MAIN RESULTS There were 146 infants in the Pre-E cohort and 143 in the control cohort. The Pre-E cohort was further divided into nonsevere (N = 41) and severe (N = 105) groups. There was no significant difference in DLCO and DLCO/alveolar volume among the three groups. Forced vital capacity was similar among the three groups, but the nonsevere Pre-E group had significantly higher forced expiratory flows than the other two groups. After adjusting for multiple covariates including prematurity, the severe Pre-E group had a lower risk for wheezing in the first year of life compared to the other two groups. CONCLUSIONS Pre-E is not associated with reduced DLCO, lower forced expiratory flows, or increased wheezing in the first year of life. These results differ from animal models and highlight the complex relationships between Pre-E and lung function and respiratory morbidity in human infants.
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Affiliation(s)
- Clement L. Ren
- Division of Pulmonary and Sleep MedicineChildren's Hospital of PhiladephiaPhiladelphiaPennsylvaniaUSA
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James E. Slaven
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - David M. Haas
- Department of Obstetrics and GynecologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Laura S. Haneline
- Department of Pediatrics, Division of Neonatal‐Perinatal MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Christina Tiller
- Department of Pediatrics, Division of Pulmonary, Allergy, and Sleep MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Graham Hogg
- Department of Obstetrics and GynecologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jeffrey Bjerregaard
- Department of Pediatrics, Division of Pulmonary, Allergy, and Sleep MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Robert S. Tepper
- Department of Pediatrics, Division of Pulmonary, Allergy, and Sleep MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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2
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Seidl E, Schwerk N, Carlens J, Wetzke M, Emiralioğlu N, Kiper N, Lange J, Krenke K, Szepfalusi Z, Stehling F, Baden W, Hämmerling S, Jerkic SP, Proesmans M, Ullmann N, Buchvald F, Knoflach K, Kappler M, Griese M. Acute exacerbations in children's interstitial lung disease. Thorax 2022; 77:799-804. [PMID: 35149584 DOI: 10.1136/thoraxjnl-2021-217941] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acute exacerbations (AEs) increase morbidity and mortality of patients with chronic pulmonary diseases. Little is known about the characteristics and impact of AEs on children's interstitial lung disease (chILD). METHODS The Kids Lung Register collected data on AEs, the clinical course and quality of life (patient-reported outcomes - PRO) of rare paediatric lung diseases. Characteristics of AEs were obtained. RESULTS Data of 2822 AEs and 2887 register visits of 719 patients with chILD were recorded. AEs were characterised by increased levels of dyspnoea (74.1%), increased respiratory rate (58.6%) and increased oxygen demand (57.4%). Mostly, infections (94.4%) were suspected causing an AE. AEs between two register visits revealed a decline in predicted FEV1 (median -1.6%, IQR -8.0 to 3.9; p=0.001), predicted FVC (median -1.8%, IQR -7.5 to 3.9; p=0.004), chILD-specific questionnaire (median -1.3%, IQR -3.6 to 4.5; p=0.034) and the physical health summary score (median -3.1%, IQR -15.6 to 4.3; p=0.005) compared with no AEs in between visits. During the median observational period of 2.5 years (IQR 1.2-4.6), 81 patients died. For 49 of these patients (60.5%), mortality was associated with an AE. CONCLUSION This is the first comprehensive study analysing the characteristics and impact on the clinical course of AEs in chILD. AEs have a significant and deleterious effect on the clinical course and health-related quality of life in chILD.
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Affiliation(s)
- Elias Seidl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, German Center for Lung Research, Munich, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Julia Carlens
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Martin Wetzke
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Nagehan Emiralioğlu
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey, Ankara, Turkey
| | - Nural Kiper
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey, Ankara, Turkey
| | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Zsolt Szepfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Departement of Pediatrics and Adolescent Medicine, Comprehensive Center of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Florian Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, University Children's Hospital Essen, Essen, Germany
| | - Winfried Baden
- Department of Pediatrics 2, Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Susanne Hämmerling
- Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University of Heidelberg, Germany, Heidelberg, Germany
| | - Silvija-Pera Jerkic
- Department of Allergy, Pneumology, and Cystic Fibrosis, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Marijke Proesmans
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Flanders, Belgium
| | - Nicola Ullmann
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Roma, Italy
| | - Frederik Buchvald
- Department of Paediatrics and Adolescent Medicine, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark
| | - Katrin Knoflach
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, German Center for Lung Research, Munich, Germany
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, German Center for Lung Research, Munich, Germany
| | | | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, German Center for Lung Research, Munich, Germany
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3
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Voynow JA, Feng R, Ren CL, Dylag AM, Kemp JS, McDowell K, Sharp J, Moore PE, Eichenwald E, Panitch H, Clem C, Johnson R, Davis SD. Pulmonary function tests in extremely low gestational age infants at one year of age. Pediatr Pulmonol 2022; 57:435-447. [PMID: 34779149 DOI: 10.1002/ppul.25757] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 11/08/2022]
Abstract
RATIONALE Identifying neonatal and post-discharge exposures among extremely low gestational age newborns (ELGANs) that drive increased pulmonary morbidity and abnormal lung function at 1 year of age proves challenging. OBJECTIVE The NIH-sponsored Prematurity and Respiratory Outcomes Program (PROP), evaluated infant pulmonary function tests (iPFTs) at 1 year corrected age to determine which demographic and clinical factors are associated with abnormal lung function. METHODS iPFTs were performed on a PROP subcohort of 135 participants following Institutional Review Board (IRB)-approved written consent. Demographic data, Neonatal Intensive Care Unit (NICU) clinical care, and post-NICU exposures were analyzed for association with iPFTs. MAIN RESULTS A significant decrease in forced expiratory volume at 0.5 s (FEV0.5 ) and/or forced expiratory flows at 75% of forced vital capacity (FEF75 ), were associated with male sex and African American race. Clinical factors including longer duration of ventilatory support, exposure to systemic steroids, and weight less than the 10th percentile at 36 weeks postmenstrual age were also associated with airflow obstruction, whereas supplemental oxygen requirement and bronchopulmonary dysplasia were not. Additionally, the need for respiratory medications, technology, or hospitalizations during the first year, ascertained by a quarterly survey, were the only post-NICU factors associated with decreased FEV0.5 and FEF75 . Only 7% of infants had reversible airflow obstruction. CONCLUSIONS Neonatal demographic factors, respiratory support in the NICU, and a history of greater post-NICU medical utilization for respiratory disease had the strongest association with lower lung function at 1 year in ELGANs.
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Affiliation(s)
- Judith A Voynow
- Division of Pediatric Pulmonology, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Rui Feng
- Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clement L Ren
- Division of Pediatric Pulmonology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Pediatric Pulmonology, University of Rochester, Rochester, New York, USA.,Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
| | - Andrew M Dylag
- Division of Neonatology, University of Rochester, Rochester, New York, USA
| | - James S Kemp
- Division of Pediatric Pulmonology, Washington University Medical Center, St. Louis, Missouri, USA
| | - Karen McDowell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jack Sharp
- Division of Pediatric Pulmonology, Duke University Medical Center, Durham, North Carolina, USA.,Division of Pediatric Pulmonology, Texas Children's Hospital, Woodlands, Texas, USA
| | - Paul E Moore
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Eichenwald
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Neonatology, University of Texas Health Science Center- Houston, Houston, Texas, USA
| | - Howard Panitch
- Division of Pediatric Pulmonology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Charles Clem
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
| | - Robin Johnson
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Stephanie D Davis
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA.,Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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4
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DeBoer EM, Kimbell JS, Pickett K, Hatch JE, Akers K, Brinton J, Hall GL, King L, Ramanauskas F, Rosenow T, Stick SM, Tiddens HA, Ferkol TW, Ranganathan SC, Davis SD. Lung inflammation and simulated airway resistance in infants with cystic fibrosis. Respir Physiol Neurobiol 2021; 293:103722. [PMID: 34157384 PMCID: PMC8330801 DOI: 10.1016/j.resp.2021.103722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022]
Abstract
Cystic fibrosis (CF) is characterized by small airway disease; but central airways may also be affected. We hypothesized that airway resistance estimated from computational fluid dynamic (CFD) methodology in infants with CF was higher than controls and that early airway inflammation in infants with CF is associated with airway resistance. Central airway models with a median of 51 bronchial outlets per model (interquartile range 46,56) were created from chest computed tomography scans of 18 infants with CF and 7 controls. Steady state airflow into the trachea was simulated to estimate central airway resistance in each model. Airway resistance was increased in the full airway models of infants with CF versus controls and in models trimmed to 33 bronchi. Airway resistance was associated with markers of inflammation in bronchoalveolar lavage fluid obtained approximately 8 months earlier but not with markers obtained at the same time. In conclusion, airway resistance estimated by CFD modeling is increased in infants with CF compared to controls and may be related to early airway inflammation.
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Affiliation(s)
- Emily M DeBoer
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Breathing Institute at Children's Hospital Colorado, Aurora, CO, United States.
| | - Julia S Kimbell
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Kaci Pickett
- Colorado School of Public Health, Aurora, CO, United States
| | - Joseph E Hatch
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Kathryn Akers
- Washington University School of Medicine, St. Louis, MO, United States
| | - John Brinton
- Breathing Institute at Children's Hospital Colorado, Aurora, CO, United States; Colorado School of Public Health, Aurora, CO, United States
| | - Graham L Hall
- Telethon Kids Institute and Perth Children's Hospital, U. of Western Australia, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Louise King
- Royal Children's Hospital and Murdoch Children's Research Institute, U. of Melbourne, Parkville, VIC, Australia
| | - Fiona Ramanauskas
- Royal Children's Hospital and Murdoch Children's Research Institute, U. of Melbourne, Parkville, VIC, Australia
| | - Tim Rosenow
- Telethon Kids Institute and Perth Children's Hospital, U. of Western Australia, Perth, WA, Australia
| | - Stephen M Stick
- Telethon Kids Institute and Perth Children's Hospital, U. of Western Australia, Perth, WA, Australia
| | - Harm A Tiddens
- Erasmus MC and Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Thomas W Ferkol
- Washington University School of Medicine, St. Louis, MO, United States
| | - Sarath C Ranganathan
- Royal Children's Hospital and Murdoch Children's Research Institute, U. of Melbourne, Parkville, VIC, Australia
| | - Stephanie D Davis
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
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5
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Muston HN, Slaven JE, Tiller C, Clem C, Ferkol TW, Ranganathan S, Davis SD, Ren CL. Hyperinflation is associated with increased respiratory rate and is a more sensitive measure of cystic fibrosis lung disease during infancy compared to forced expiratory measures. Pediatr Pulmonol 2021; 56:2854-2860. [PMID: 34143539 PMCID: PMC8373786 DOI: 10.1002/ppul.25538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The goal of this study was to identify clinical features associated with abnormal infant pulmonary function tests (iPFTs), specifically functional residual capacity (FRC), in infants with cystic fibrosis (CF) diagnosed via newborn screen (NBS). We hypothesized that poor nutritional status in the first 6-12 months would be associated with increased FRC at 12-24 months. METHODS This study utilized a combination of retrospectively and prospectively collected data from ongoing research studies and iPFTs performed for clinical indications. Demographic and clinical features were obtained from the electronic medical record. Forced expiratory flows and volumes were obtained using the raised volume rapid thoracoabdominal technique (RVRTC) and FRC was measured via plethysmography. RESULTS A total of 45 CF NBS infants had iPFTs performed between 12 and 24 months. Mean forced vital capacity, forced expiratory volume in 0.5 s, and forced expiratory flows were all within normal limits. In contrast, the mean FRC z-score was 2.18 (95% confidence interval [CI] = 1.48, 2.88) and the mean respiratory rate (RR) z-score was 1.42 (95% CI = 0.95, 1.89). There was no significant association between poor nutritional status and abnormal lung function. However, there was a significant association between higher RR and increased FRC, and a RR cutoff of 36 breaths/min resulted in 92% sensitivity to detect hyperinflation with 32% specificity. CONCLUSION These results suggest that FRC is a more sensitive measure of early CF lung disease than RVRTC measurements and that RR may be a simple, noninvasive clinical marker to identify CF NBS infants with hyperinflation.
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Affiliation(s)
- Heather N Muston
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christina Tiller
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles Clem
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas W Ferkol
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sarath Ranganathan
- Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Stephanie D Davis
- Department of Pediatrics, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Clement L Ren
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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6
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Muston HN, Perrem L, Davis MD, Ratjen F, Ren CL. The remaining barriers to normalcy in CF: Advances in assessment of CF lung disease. Pediatr Pulmonol 2021; 56 Suppl 1:S90-S96. [PMID: 32589821 DOI: 10.1002/ppul.24929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022]
Abstract
Despite early diagnosis of cystic fibrosis (CF) through newborn screening, a substantial proportion of infants and young children with CF still demonstrate physiologic and structural evidence of lung disease progression, such as obstructive airway disease and bronchiectasis. The growing availability of highly effective CF transmembrane conductance regulatory modulator therapy to the vast majority of people with CF has led to the potential to alter the natural history of CF lung disease, but to assess the full impact of these therapies on CF lung disease and to help guide treatment, sensitive measures of early and mild disease are needed. Chest imaging using computed tomography or magnetic resonance imaging is one approach, but technologic barriers and/or concern about exposure to ionizing radiation may limit its use. However, advances in physiologic measurement techniques and exhaled breath analysis offer another option for assessment of CF lung disease.
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Affiliation(s)
- Heather N Muston
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indianapolis, Indiana
| | - Lucy Perrem
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Michael D Davis
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indianapolis, Indiana
| | - Felix Ratjen
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Clement L Ren
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indianapolis, Indiana
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7
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Walicka-Serzysko K, Postek M, Milczewska J, Sands D. Lung function deterioration in school children with cystic fibrosis. Pediatr Pulmonol 2020; 55:3030-3038. [PMID: 32761970 DOI: 10.1002/ppul.25013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Lung disease in cystic fibrosis (CF) begins early in life but the capabilities for detecting abnormalities of pulmonary dysfunction in children remain limited. OBJECTIVE The study aimed to evaluate the early progression of lung function by the analysis of pulmonary hyperinflation, ventilation inhomogeneity (VI), trapped gas and airway obstruction with age. METHODS One hundred CF children aged 7 to 18, divided into two groups aged 7 to 12 (n = 40) and 13 to 18 (n = 60), were enrolled. Patients performed multiple-breath nitrogen washout (MBNW) tests and plethysmography for measurements of lung clearance index (LCI), functional residual capacity (FRCpleth , FRCMBNW ), volume of trapped gas (VT ), total resistance, and effective and specific effective airway resistance (Reff , sReff ). RESULTS We obtained a positive correlation of FRCpleth , FRCMBNW , and LCI with age. A linear correlation between FRCMBNW and FRCpleth (P < .0001) was observed. VI was higher in the group of older patients (9.79 in the group aged 7-12 and 11.67 in the group aged 13-18). An increased effective specific airway resistance >2 (z-score) was present in 58% of all subjects (50% and 63.3%, respectively). Pulmonary hyperinflation (FRCpleth >2 z-score) was observed in 33% of all patients: 25% and 36.6%, respectively. Trapped gas (VT > 2 z-score) was present in 18% of all children: 30% and 10%, respectively. CONCLUSION A gradual decline in lung function is associated with an increase in VI, airway obstruction, pulmonary hyperinflation and development of trapped gas. In children who cannot perform either spirometry or plethysmography, MBNW can deliver a measurement of LCI connecting with VI as well as FRCMBNW to indicate indirectly the increase of hyperinflation.
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Affiliation(s)
- Katarzyna Walicka-Serzysko
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Clinical Department of Lung Diseases, Pediatric Hospital, Dziekanow Lesny, Poland
| | - Magdalena Postek
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Clinical Department of Lung Diseases, Pediatric Hospital, Dziekanow Lesny, Poland
| | - Justyna Milczewska
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Clinical Department of Lung Diseases, Pediatric Hospital, Dziekanow Lesny, Poland
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Centre, Clinical Department of Lung Diseases, Pediatric Hospital, Dziekanow Lesny, Poland
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8
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Dylag AM, Kopin HG, O’Reilly MA, Wang H, Davis SD, Ren CL, Pryhuber GS. Early Neonatal Oxygen Exposure Predicts Pulmonary Morbidity and Functional Deficits at 1 Year. J Pediatr 2020; 223:20-28.e2. [PMID: 32711747 PMCID: PMC9337224 DOI: 10.1016/j.jpeds.2020.04.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/09/2020] [Accepted: 04/14/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the predictive value of cumulative oxygen exposure thresholds over the first 2 postnatal weeks, linking them to bronchopulmonary dysplasia (BPD) and 1-year pulmonary morbidity and lung function in extremely low gestational age newborns. STUDY DESIGN Infants (N = 704) enrolled in the Prematurity and Respiratory Outcomes Program, a multicenter prospective cohort study, that survived to discharge were followed through their neonatal intensive care unit hospitalization to 1-year corrected age. Cumulative oxygen exposure (OxygenAUC14) thresholds were derived from univariate models of BPD, stratifying infants into high-, intermediate-, and low-oxygen exposure groups. These groups were then used in multivariate logistic regressions to prospectively predict post-prematurity respiratory disease (PRD), respiratory morbidity score (RMS) in the entire cohort, and pulmonary function z scores (N = 108 subset of infants) at 1-year corrected age. RESULTS Over the first 14 postnatal days, infants exposed to high oxygen averaged ≥33.1% oxygen, infants exposed to intermediate oxygen averaged 29.1%-33.1%, and infants exposed to low oxygen were below both cutoffs. In multivariate models, infants exposed to high oxygen showed increased PRD and RMS, whereas infants exposed to intermediate oxygen demonstrated increased moderate/severe RMS. Infants in the high/intermediate groups had decreased forced expiratory volume at 0.5 seconds/forced vital capacity ratio. CONCLUSIONS OxygenAUC14 establishes 3 thresholds of oxygen exposure that risk stratify infants early in their neonatal course, thereby predicting short-term (BPD) and 1-year (PRD, RMS) respiratory morbidity. Infants with greater OxygenAUC14 have altered pulmonary function tests at 1 year of age, indicating early evidence of obstructive lung disease and flow limitation, which may predispose extremely low gestational age newborns to increased long-term pulmonary morbidity. TRIAL REGISTRATION ClinicalTrials.gov: NCT01435187.
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Affiliation(s)
- Andrew M. Dylag
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY
| | - Hannah G. Kopin
- School of Medicine, School of Public Health Sciences, University of Rochester, Rochester, NY
| | - Michael A. O’Reilly
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Clement L. Ren
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University, Indianapolis, IN
| | - Gloria S. Pryhuber
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY
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9
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Chotzoglou E, Hedrick HL, Herkert LM, Goldshore MA, Rintoul NE, Panitch HB. Therapy at 30 days of life predicts lung function at 6 to 12 months in infants with congenital diaphragmatic hernia. Pediatr Pulmonol 2020; 55:1456-1467. [PMID: 32191392 DOI: 10.1002/ppul.24736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/09/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) is associated with variable degrees of lung hypoplasia. Pulmonary support at 30 days postnatal age was found to be the strongest predictor of inpatient mortality and morbidity among CDH infants and was also associated with higher pulmonary morbidity at 1 and 5 years. It is not known, however, if there is a relationship between the need for medical therapy at 30 days of life and subsequent abnormalities in lung function as reflected in infant pulmonary function test (iPFT) measurements. OBJECTIVE We hypothesized that CDH infants who require more intensive therapy at 30 days would have more abnormal iPFT values at the time of their first infant pulmonary function study, reflecting the more severe spectrum of lung hypoplasia. METHODS A single-institution chart review of all CDH survivors who were enrolled in a Pulmonary Hypoplasia Program (PHP) through July 2019, and treated from 2002 to 2019 was performed. All infants were divided into groups based on their need for noninvasive (supplemental oxygen, high flow therapy, noninvasive mechanical ventilation) or invasive (mechanical ventilation, extracorporeal membrane oxygenation) respiratory assistance, bronchodilators, diuretic use, and pulmonary hypertension (PH) therapy (inhaled and/or systemic drugs) at 30 days. Descriptive and statistical analyses were performed between groups comparing subsequent lung function measurements. RESULTS A total of 382 infants (median gestational age [GA] 38.4 [interquartile range (IQR) = 37.1-39] weeks, 41.8% female, 70.9% Caucasian) with CDH were enrolled in the PHP through July 2019, and 118 infants underwent iPFT. The median age of the first iPFT was 6.6 (IQR = 5.3-11.7) months. Those requiring any pulmonary support at 30 days had a higher functional residual capacity (FRC) (z) (P = .03), residual volume (RV) (z) (P = .008), ratio of RV to total lung capacity (RV/TLC) (z) (P = .0001), and ratio of FRC to TLC (FRC/TLC) (z) (P = .001); a lower forced expiratory volume at 0.5 seconds (FEV0.5) (z) (P = .03) and a lower respiratory system compliance (Crs) (P = .01) than those who did not require any support. Similarly, those requiring diuretics and/or PH therapy at 30 days had higher fractional lung volumes, lower forced expiratory flows and Crs than infants who did not require such support (P < .05). CONCLUSIONS Infants requiring any pulmonary support, diuretics and/or PH therapy at 30 postnatal days have lower forced expiratory flows and higher fractional lung volumes, suggesting a greater degree of lung hypoplasia. Our study suggests that the continued need for PH, diuretic or pulmonary support therapy at 30 days can be used as additional risk-stratification measurements for evaluation of infants with CDH.
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Affiliation(s)
- Etze Chotzoglou
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holly L Hedrick
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa M Herkert
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew A Goldshore
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie E Rintoul
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Howard B Panitch
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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10
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11
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Collaco JM, Abman SH. Evolving Challenges in Pediatric Pulmonary Medicine. New Opportunities to Reinvigorate the Field. Am J Respir Crit Care Med 2018; 198:724-729. [DOI: 10.1164/rccm.201709-1902pp] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Joseph M. Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Steven H. Abman
- Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Denver and Children’s Hospital Colorado, Denver, Colorado
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12
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Lu Z, Foong RE, Kowalik K, Moraes TJ, Dubeau A, Lefebvre D, Davis SD, Balkovec S, Becker A, Mandhane P, Turvey SE, Lou W, Sears MR, Ratjen F, Subbarao P. Reference equations for the interpretation of forced expiratory and plethysmographic measurements in infants. Pediatr Pulmonol 2018; 53:907-916. [PMID: 29790670 DOI: 10.1002/ppul.24063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pulmonary function testing is commonly performed for diagnosis and clinical management of respiratory diseases. It is important to use appropriate reference equations from healthy subjects for interpretation of data from infants with lung disease. This study aimed to determine if published reference equations were similar to forced flow measures and plethysmographic infant pulmonary function testing data collected in the Canadian Healthy Infant Longitudinal Development (CHILD) Study. METHODS Reference equations for five pulmonary function variables (FEV0.5 , FVC, FEF25-75 , FEV0.5 /FVC ratio and plethysmography (FRCpleth )) were developed using data from the nSpire system. New reference equations developed using healthy data from the CHILD Study were compared to previously published reference equations for forced flow and plethysmographic measures. RESULTS The current analysis included 131 infants (on 181 test occasions) with forced flow measures and 161 infants (on 246 test occasions) with plethysmography measures, aged 3-24 months. Age and length were major determinants of both forced flow and plethysmography measures. In addition, ethnicity (Caucasian vs non-Caucasian) was significantly associated with FEV0.5 /FVC and FEF25-75 measures. We found that the published reference equations based on custom-built equipment or commercially available systems provided poor fit to our current pulmonary function testing data, resulting in placing a large proportion of our healthy population outside the normal ranges. CONCLUSIONS Our current data support the need for population and device specific reference data for infant pulmonary function studies. By deriving new equipment-specific reference equations for our healthy population, we provide normative data to other centers utilizing this equipment.
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Affiliation(s)
- Zihang Lu
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rachel E Foong
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Curtin University of Technology, Perth, Western Australia
| | - Krzysztof Kowalik
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Aimee Dubeau
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Diana Lefebvre
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Stephanie D Davis
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine; Department of Pediatrics; Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Susan Balkovec
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Allan Becker
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Child & Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, and Program in Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Stahl M, Graeber SY, Joachim C, Barth S, Ricklefs I, Diekmann G, Kopp MV, Naehrlich L, Mall MA. Three-center feasibility of lung clearance index in infants and preschool children with cystic fibrosis and other lung diseases. J Cyst Fibros 2018; 17:249-255. [PMID: 28811149 DOI: 10.1016/j.jcf.2017.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lung clearance index (LCI) detects early ventilation inhomogeneity and has been suggested as sensitive endpoint in multicenter intervention trials in infants and preschoolers with cystic fibrosis (CF). However, the feasibility of multicenter LCI in this age group has not been determined. We, therefore, investigated the feasibility of LCI in infants and preschoolers with and without CF in a three-center setting. METHODS Following central training, standardized SF6-MBW measurements were performed in 73 sedated children (10 controls, 49 with CF and 14 with other lung diseases), mean age 2.3±1.2years across three centers, and data were analyzed centrally. RESULTS Overall success rate of LCI measurements was 91.8% ranging from 78.9% to 100% across study sites. LCI was increased in patients with CF (P<0.05) and with other lung diseases (P<0.05) compared to controls. CONCLUSION Our results support feasibility of LCI as multicenter endpoint in clinical trials in infants and preschoolers with CF.
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Affiliation(s)
- Mirjam Stahl
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany; Department of Translational Pulmonology, Translational Lung Research Center Heidelberg (TLRC), German Centre for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany.
| | - Simon Y Graeber
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany; Department of Translational Pulmonology, Translational Lung Research Center Heidelberg (TLRC), German Centre for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
| | - Cornelia Joachim
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany; Department of Translational Pulmonology, Translational Lung Research Center Heidelberg (TLRC), German Centre for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany
| | - Sandra Barth
- Department of Pediatrics, Justus-Liebig-University Giessen, Feulgenstrasse 10-12, 35392 Giessen, Germany; Universities Giessen and Marburg Lung Centre (UGMLC), German Centre for Lung Research (DZL), Aulweg 130, 35392 Giessen, Germany
| | - Isabell Ricklefs
- Department of Pediatric Allergology and Pneumology, Medical University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Airway Research Centre North (ARCN), German Centre for Lung Research (DZL), Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Gesa Diekmann
- Department of Pediatric Allergology and Pneumology, Medical University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Airway Research Centre North (ARCN), German Centre for Lung Research (DZL), Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Matthias V Kopp
- Department of Pediatric Allergology and Pneumology, Medical University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Airway Research Centre North (ARCN), German Centre for Lung Research (DZL), Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Feulgenstrasse 10-12, 35392 Giessen, Germany; Universities Giessen and Marburg Lung Centre (UGMLC), German Centre for Lung Research (DZL), Aulweg 130, 35392 Giessen, Germany
| | - Marcus A Mall
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany; Department of Translational Pulmonology, Translational Lung Research Center Heidelberg (TLRC), German Centre for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany; Department of Pediatric Pulmonology and Immunology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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14
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Davies G, Stocks J, Thia LP, Hoo AF, Bush A, Aurora P, Brennan L, Lee S, Lum S, Cottam P, Miles J, Chudleigh J, Kirkby J, Balfour-Lynn IM, Carr SB, Wallis C, Wyatt H, Wade A. Pulmonary function deficits in newborn screened infants with cystic fibrosis managed with standard UK care are mild and transient. Eur Respir J 2017; 50:50/5/1700326. [PMID: 29122914 DOI: 10.1183/13993003.00326-2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 08/03/2017] [Indexed: 12/17/2022]
Abstract
With the advent of novel designer molecules for cystic fibrosis (CF) treatment, there is huge need for early-life clinical trial outcomes, such as infant lung function (ILF). We investigated the degree and tracking of ILF abnormality during the first 2 years of life in CF newborn screened infants.Forced expiratory volume in 0.5 s (FEV0.5), lung clearance index (LCI) and plethysmographic functional residual capacity were measured at ∼3 months, 1 year and 2 years in 62 infants with CF and 34 controls.By 2 years there was no significant difference in FEV0.5 z-score between CF and controls, whereas mean LCI z-score was 0.81 (95% CI 0.45-1.17) higher in CF. However, there was no significant association between LCI z-score at 2 years with either 3-month or 1-year results. Despite minimal average group changes in any ILF outcome during the second year of life, marked within-subject changes occurred. No child had abnormal LCI or FEV0.5 on all test occasions, precluding the ability to identify "high-risk" infants in early life.In conclusion, changes in lung function are mild and transient during the first 2 years of life in newborn screened infants with CF when managed according to a standardised UK treatment protocol. Their potential role in tracking disease to later childhood will be ascertained by ongoing follow-up.
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Affiliation(s)
- Gwyneth Davies
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK .,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Janet Stocks
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lena P Thia
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ah-Fong Hoo
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Paul Aurora
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucy Brennan
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Simon Lee
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sooky Lum
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Philippa Cottam
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Joanne Miles
- Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jane Chudleigh
- Dept of Child Health, King's College London, London, UK.,Dept of Child Health, City, University of London, London, UK
| | - Jane Kirkby
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ian M Balfour-Lynn
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Siobhán B Carr
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,Dept of Paediatric Respiratory Medicine, Royal London Hospital, London, UK
| | - Colin Wallis
- Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Hilary Wyatt
- Dept of Child Health, King's College London, London, UK
| | - Angie Wade
- Clinical Epidemiology, Nutrition and Biostatistics, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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15
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Gauthier R, Cabon Y, Giroux-Metges MA, Du Boisbaudry C, Reix P, Le Bourgeois M, Chiron R, Molinari N, Saguintaah M, Amsallem F, Matecki S. Early follow-up of lung disease in infants with cystic fibrosis using the raised volume rapid thoracic compression technique and computed tomography during quiet breathing. Pediatr Pulmonol 2017; 52:1283-1290. [PMID: 28861941 DOI: 10.1002/ppul.23786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among the different techniques used to monitor lung disease progression in infants with CF diagnosed by Newborn screening (NBS), raised volume-rapid thoracic compression (RVRTC) remains a promising tool. However, the need of sedation and positive pressure ventilation considerably limits its clinical use. We recently described a semi-quantitative method to evaluate air trapping by chest tomography during quite breathing without sedation (CTqb score). This parameter is the radiological sign of airway obstruction and could be also used for lung disease follow-up in infants with CF. However, its discriminative power compared with RVRTC and correlation with lung function parameters are not known. OBJECTIVES To compare the discriminative powers of the CTqb score and RVRTC parameters and to determine their correlation during the first year of life of infants with CF. METHODS In this multicenter longitudinal study, infants with CF diagnosed by NBS underwent RVRTC and CT during quite breathing at 10 ± 4 weeks (n = 30) and then at 13 ± 1 months of age (n = 28). RESULTS All RVRTC parameters and the CTqb score remained stable between evaluations. The CTqb score showed a higher discriminative power than forced expiratory volume in 0.5 s (FEV0.5 ; the main RVRTC parameter) at both visits (66% and 50% of abnormal values vs 30% and 28%, respectively). No correlation was found between CTqb score and, the different RVRTC parameters or the plethysmographic functional residual capacity, indicating that they evaluate different aspect of CF lung disease.
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Affiliation(s)
- Rémi Gauthier
- Pediatric Functional Exploration Unit, Hôpital Nord, Amiens University Hospital, Amiens, France
| | - Yann Cabon
- Medical Informatics Department, Montpellier University Hospital, Montpellier, France
| | | | | | - Phillipe Reix
- Pediatric Functional Exploration Unit, CF Center Lyon University Hospital, Paris, France
| | - Muriel Le Bourgeois
- Pediatric Functional Exploration Unit and CF Center, Necker University Hospital, Paris, France
| | - Raphael Chiron
- Cystic Fibrosis Center, Montpellier University Hospital, France
| | - Nicolas Molinari
- Medical Informatics Department, Montpellier University Hospital, Montpellier, France
| | - Magali Saguintaah
- Pediatric Imaging Department, Montpellier University Hospital, France
| | - Francis Amsallem
- Pediatric Functional Exploration Unit, UMR CNRS 9214-Inserm, U1046, Montpellier University Hospital, Montpellier, France
| | - Stefan Matecki
- Pediatric Functional Exploration Unit, UMR CNRS 9214-Inserm, U1046, Montpellier University Hospital, Montpellier, France
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16
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Lai SH, Liao SL, Yao TC, Tsai MH, Hua MC, Chiu CY, Yeh KW, Huang JL. Raised-Volume Forced Expiratory Flow-Volume Curve in Healthy Taiwanese Infants. Sci Rep 2017; 7:6314. [PMID: 28740164 PMCID: PMC5524959 DOI: 10.1038/s41598-017-06815-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/19/2017] [Indexed: 01/15/2023] Open
Abstract
The raised-volume rapid thoracoabdominal compression (RVRTC) manoeuvre has been applied to obtain full forced expiratory flow-volume curves in infants. No reference data are available for Asian populations. This study was conducted to establish predictive reference equations for Taiwanese infants. Full-term infants without any chronic disease or major anomaly were enrolled from this cohort study. Full forced expiratory flow-volume curves were acquired using RVRTC manoeuvres through Jaeger's system. Tidal breath analysis, passive respiratory mechanics, and tidal forced expiratory flow-volume curves were performed and collected at the same measurement. Multiple linear analyses were used to model the variables. We performed 117 tests of RVRTC flow-volume curves in 97 infants. The results revealed that all parameters, except for FEV0.5 /FVC, correlated highly and positively with body length. These parameters correlated significantly with other parameters of passive respiratory mechanics and tidal forced expiratory flow-volume curves. This is the first study to establish equipment-specific reference data of full forced expiration using RVRTC manoeuvres in Asian infants. The results revealed that parameters of RVRTC manoeuvres are moderately related to other parameters of infant lung function. These race-specific reference data can be used to more precisely and efficiently diagnose respiratory diseases in infants of Chinese ethnicity.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan. .,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan.
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Abstract
Cystic fibrosis (CF) is the most common autosomal-recessive disease in white persons. Significant advances in therapies and outcomes have occurred for people with CF over the past 30 years. Many of these improvements have come about through the concerted efforts of the CF Foundation and international CF societies; networks of CF care centers; and the worldwide community of care providers, researchers, and patients and families. There are still hurdles to overcome to continue to improve the quality of life, reduce CF complications, prolong survival, and ultimately cure CF. This article reviews the epidemiology of CF, including trends in incidence and prevalence, clinical characteristics, common complications, and survival.
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Affiliation(s)
- Don B. Sanders
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aliza Fink
- Epidemiology, Cystic Fibrosis Foundation, Bethesda, Maryland
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18
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Physiologic endpoints for clinical studies for cystic fibrosis. J Cyst Fibros 2016; 15:416-23. [DOI: 10.1016/j.jcf.2016.05.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 11/20/2022]
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19
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Ramsey KA, Rosenow T, Turkovic L, Skoric B, Banton G, Adams AM, Simpson SJ, Murray C, Ranganathan SC, Stick SM, Hall GL. Lung Clearance Index and Structural Lung Disease on Computed Tomography in Early Cystic Fibrosis. Am J Respir Crit Care Med 2016; 193:60-7. [PMID: 26359952 DOI: 10.1164/rccm.201507-1409oc] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE The lung clearance index is a measure of ventilation distribution derived from the multiple-breath washout technique. It has been suggested as a surrogate for chest computed tomography to detect structural lung abnormalities in individuals with cystic fibrosis (CF); however, the associations between lung clearance index and early structural lung disease are unclear. OBJECTIVES We assessed the ability of the lung clearance index to reflect structural lung disease on the basis of chest computed tomography across the entire pediatric age range. METHODS Lung clearance index was assessed in 42 infants (ages 0-2 yr), 39 preschool children (ages 3-6 yr), and 38 school-age children (7-16 yr) with CF before chest computed tomography and in 72 healthy control subjects. Scans were evaluated for CF-related structural lung disease using the Perth-Rotterdam Annotated Grid Morphometric Analysis for Cystic Fibrosis quantitative outcome measure. MEASUREMENTS AND MAIN RESULTS In infants with CF, lung clearance index is insensitive to structural disease (κ = -0.03 [95% confidence interval, -0.05 to 0.16]). In preschool children with CF, lung clearance index correlates with total disease extent. In school-age children, lung clearance index correlates with extent of total disease, bronchiectasis, and air trapping. In preschool and school-age children, lung clearance index has a good positive predictive value (83-86%) but a poor negative predictive value (50-55%) to detect the presence of bronchiectasis. CONCLUSIONS These data suggest that lung clearance index may be a useful surveillance tool to monitor structural lung disease in preschool and school-age children with CF. However, lung clearance index cannot replace chest computed tomography to screen for bronchiectasis in this population.
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Affiliation(s)
- Kathryn A Ramsey
- 1 Telethon Kids Institute and.,2 Cystic Fibrosis Research and Treatment Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tim Rosenow
- 1 Telethon Kids Institute and.,3 School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
| | | | - Billy Skoric
- 4 Murdoch Children's Research Institute, Parkville, Australia.,5 Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
| | | | - Anne-Marie Adams
- 4 Murdoch Children's Research Institute, Parkville, Australia.,5 Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
| | | | | | - Sarath C Ranganathan
- 4 Murdoch Children's Research Institute, Parkville, Australia.,5 Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia.,7 Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Stephen M Stick
- 1 Telethon Kids Institute and.,8 Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Australia; and
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20
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Multiple-Breath Washout as a Lung Function Test in Cystic Fibrosis. A Cystic Fibrosis Foundation Workshop Report. Ann Am Thorac Soc 2016; 12:932-9. [PMID: 26075554 DOI: 10.1513/annalsats.201501-021fr] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The lung clearance index (LCI) is a lung function parameter derived from the multiple-breath washout (MBW) test. Although first developed 60 years ago, the technique was not widely used for many years. Recent technological advances in equipment design have produced gains in popularity for this test among cystic fibrosis (CF) researchers and clinicians, particularly for testing preschool-aged children. LCI has been shown to be feasible and sensitive to early CF lung disease in patients of all ages from infancy to adulthood. A workshop was convened in January 2014 by the North American Cystic Fibrosis Foundation to determine the readiness of the LCI for use in multicenter clinical trials as well as clinical care. The workshop concluded that the MBW text is a valuable potential outcome measure for CF clinical trials in preschool-aged patients and in older patients with FEV1 in the normal range. However, gaps in knowledge about the choice of device, gas, and standardization across systems are key issues precluding its use as a clinical trial end point in infants. Based on the current evidence, there are insufficient data to support the use of LCI or MBW parameters in the routine clinical management of patients with CF.
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21
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Anagnostopoulou P, Egger B, Lurà M, Usemann J, Schmidt A, Gorlanova O, Korten I, Roos M, Frey U, Latzin P. Multiple breath washout analysis in infants: quality assessment and recommendations for improvement. Physiol Meas 2016; 37:L1-L15. [DOI: 10.1088/0967-3334/37/3/l1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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22
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Subbarao P, Lu Z, Kowalik K, Brown M, Balkovec S, Gustafsson P, Lou W, Ratjen F. Changes in multiple breath washout measures after raised volume rapid thoracoabdominal compression maneuvers in infants. Pediatr Pulmonol 2016; 51:183-8. [PMID: 26383784 DOI: 10.1002/ppul.23220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/13/2015] [Accepted: 05/08/2015] [Indexed: 11/08/2022]
Abstract
Multiple breath inert gas washout (MBW) measurements in infants are performed supine and often obtained under sedation and thus are combined with other lung function tests such as raised volume rapid thoracoabdominal compression (RVRTC). In this study, we sought to determine the effects of RVRTC maneuvers on MBW measures. Compared with tests performed prior to RVRTC, MBW measured after RVRTC was associated with a small reduction in functional residual capacity and a more pronounced decrease in cumulative expired volume in both healthy children and children with obstructive lung disease (cystic fibrosis or recurrent wheeze) indicating a more efficient washout after the raised volume maneuvers. Lung Clearance Index (LCI) decreased significantly in infants with respiratory disease (change in LCI of -0.24 units post RVRTC; standard error (SE) ± 0.07 units; P = 0.0004), but not in healthy infants (change in LCI of -0.08 units; SE ± 0.11 units; P = 0.44). As the RVRTC maneuver affects MBW measurements in infants, the timing of testing procedures needs to be standardized in longitudinal studies.
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Affiliation(s)
- Padmaja Subbarao
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Zihang Lu
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Krzysztof Kowalik
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Meghan Brown
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Susan Balkovec
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Per Gustafsson
- Department of Pediatrics, Central Hospital, Skövde, Sweden
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Felix Ratjen
- Department of Pediatrics and Program in Physiology and Experimental Medicine, Division of Respiratory Medicine, SickKids Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Canada
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23
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Matecki S, Kent L, de Boeck K, Le Bourgeois M, Zielen S, Braggion C, Arets H, Bradley J, Davis S, Sermet I, Reix P. Is the raised volume rapid thoracic compression technique ready for use in clinical trials in infants with cystic fibrosis? J Cyst Fibros 2016; 15:10-20. [DOI: 10.1016/j.jcf.2015.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/12/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
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Pittman JE. Assessment and Detection of Early Lung Disease in Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:212-219. [DOI: 10.1089/ped.2015.0568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jessica E. Pittman
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Missouri
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Lai SH, Liao SL, Yao TC, Tsai MH, Hua MC, Yeh KW, Huang JL. Respiratory Function in Healthy Taiwanese Infants: Tidal Breathing Analysis, Passive Mechanics, and Tidal Forced Expiration. PLoS One 2015; 10:e0142797. [PMID: 26559673 PMCID: PMC4641614 DOI: 10.1371/journal.pone.0142797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023] Open
Abstract
Background Although infant lung function (ILF) testing is widely practiced in developed Western countries it is not typically performed in Eastern countries, and lung measurements are scarce for Asian infants. Therefore, this study aimed to establish normal reference values for Taiwanese infants. Materials and Methods Full-term infants without any chronic diseases and major anomalies were enrolled in the Prediction of Allergies in Taiwanese Children (PATCH) cohort study. Detailed medical data, such as body weight and length, birth history, and histories of previous illness and hospitalization were recorded. Lung function measurements such as analysis of tidal breathing, passive respiratory mechanics, and forced tidal expiratory flow-volume curves were obtained through Jaeger Masterscreen BabyBody Paediatrics System. Multiple linear analyses were performed to determine various parameters of the lung function tests. Results ILF test parameters were collected from 126 infants, and 189 tests were performed. The results revealed that the ratio of time to peak expiratory flow to total expiratory time, the ratio of volume to peak expiratory flow to total expiratory volume, and the ratio of inspiratory time to total respiratory time remained relatively constant despite differences in age. However, body length is the strongest independent variable influencing tidal volume, respiratory rate, resistance, compliance, and maximal expiratory flow at functional residual capacity. Conclusion According to our review of relevant literature, this is the first study to establish a reference data of ILF tests in the Asian population. This study provided reference values and regression equations for several variables of lung function measurements in healthy infants aged less than 2 years. With these race-specific reference data, ILF can more precisely and efficiently diagnose respiratory diseases in infants of Chinese ethnicity.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
- * E-mail:
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Davis SD, Ratjen F, Brumback LC, Johnson RC, Filbrun AG, Kerby GS, Panitch HB, Donaldson SH, Rosenfeld M. Infant lung function tests as endpoints in the ISIS multicenter clinical trial in cystic fibrosis. J Cyst Fibros 2015; 15:386-91. [PMID: 26547590 DOI: 10.1016/j.jcf.2015.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Infant Study of Inhaled Saline (ISIS) in CF was the first multicenter clinical trial to utilize infant pulmonary function tests (iPFTs) as an endpoint. METHODS Secondary analysis of ISIS data was conducted in order to assess feasibility of iPFT measures and their associations with respiratory symptoms. Standard deviations were calculated to aid in power calculations for future clinical trials. RESULTS Seventy-three participants enrolled, 70 returned for the final visit; 62 (89%) and 45 (64%) had acceptable paired functional residual capacity (FRC) and raised volume measurements, respectively. Mean baseline FEV0.5, FEF75 and FRC z-scores were 0.3 (SD: 1.2), -0.2 (SD: 2.0), and 1.8 (SD: 2.0). CONCLUSIONS iPFTs are not appropriate primary endpoints for multicenter clinical trials due to challenges of obtaining acceptable data and near-normal average raised volume measurements. Raised volume measures have potential to serve as secondary endpoints in future clinical CF trials.
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Affiliation(s)
- Stephanie D Davis
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lyndia C Brumback
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Robin C Johnson
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy G Filbrun
- Pediatric Pulmonary Division, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Gwendolyn S Kerby
- Department of Pediatrics, The Breathing Institute, University of Colorado and Children's Hospital, Aurora, CO, USA
| | - Howard B Panitch
- Division of Pulmonary Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott H Donaldson
- Division of Pulmonary and Critical Care, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret Rosenfeld
- Division of Pulmonary Medicine, Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Panitch HB, Weiner DJ, Feng R, Perez MR, Healy F, McDonough JM, Rintoul N, Hedrick HL. Lung function over the first 3 years of life in children with congenital diaphragmatic hernia. Pediatr Pulmonol 2015; 50:896-907. [PMID: 25045135 DOI: 10.1002/ppul.23082] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 05/30/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Infants with congenital diaphragmatic hernia (CDH) have variable degrees of pulmonary hypoplasia at birth. Few reports of lung function over the first years of life exist in this group of children. HYPOTHESIS Pulmonary function abnormalities correlate with severity of neonatal disease and intensity of neonatal therapies needed. We also hypothesized that longitudinal measurements of lung function over the usual period of rapid lung growth would lend some insight into how the lung remodels in CDH infants. METHODOLOGY Ninety-eight infants with CDH between 11 days and 44 months of age underwent pulmonary function testing (PFT) on 1-5 occasions using the raised volume rapid thoracic compression technique. Demographic data were also collected. MAIN RESULTS Forced expiratory flows were below normal. Total lung capacity was normal, but residual volume and functional residual capacity were elevated. Children requiring patch closure, ECMO, or pulmonary vasodilators generally had lower lung functions at follow up. Additionally, longer duration of mechanical ventilation correlated with worse lung function. CONCLUSIONS Lung functions of survivors of CDH remain abnormal throughout the first 3 years of life. The degree of pulmonary function impairment correlated both with markers of the initial degree of pulmonary hypoplasia and the duration of mechanical ventilation. Understanding the relationship between the phenotypic presentation of CDH and the potential for subsequent lung growth could help refine both pre- and postnatal therapies to optimize lung growth in CDH infants.
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Affiliation(s)
- Howard B Panitch
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel J Weiner
- Division of Pulmonary Medicine, The Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rui Feng
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Pittsburgh, Pennsylvania
| | - Myrza R Perez
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Fiona Healy
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph M McDonough
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie Rintoul
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holly L Hedrick
- Department of General Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Healy F, Lin W, Feng R, Hanna BD, Hedrick H, Panitch HB. An association between pulmonary hypertension and impaired lung function in infants with congenital diaphragmatic hernia. Pediatr Pulmonol 2015; 50:672-82. [PMID: 24623605 DOI: 10.1002/ppul.23035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/16/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
RATIONALE Infants with congenital diaphragmatic hernia (CDH) can develop pulmonary hypertension (PH) from decreased number and abnormal muscularization of pulmonary arteries. Normally pulmonary vascular growth and remodeling parallel airspace growth and alveolarization, which exhibits a wide morphologic variation in CDH. AIM To assess whether infants with CDH and PH have greater abnormalities in infant pulmonary function testing (IPFT) compared to those without PH. METHODS We reviewed results of IPFTs and echocardiograms performed on infants with CDH from 2004 to June 2011. Lung volumes, forced flows and tidal mechanics were standardized according to available reference values. Comparisons between infants with and without PH were performed using linear regression, adjusting for potential confounders. MAIN RESULTS Sixty-six infants were included; 18 had PH and 48 did not. Z-score values for functional residual capacity (FRC), residual volume (RV), FRC/total lung capacity (TLC), and RV/TLC were significantly higher in infants with CDH and PH compared to those without PH. Z-score values for forced flows including forced expiratory volume in the first 0.5 sec (FEV0.5) and FEV0.5/forced vital capacity were significantly lower in infants with CDH and PH compared to those without PH. For 29 infants studied on ≥2 occasions, the slopes of FRC, RV, and TLC versus length were significantly higher in those with persistent PH compared to those without. CONCLUSIONS Infants with CDH and persistent PH demonstrate greater airspace overdistension with growth compared to those without. Therapies that modify disrupted pulmonary vascular and alveolar formation could potentially improve future care of these patients.
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Affiliation(s)
- Fiona Healy
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wei Lin
- Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Rui Feng
- Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Brian D Hanna
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holly Hedrick
- Department of General Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Howard B Panitch
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Respiratory consequences of prematurity: evolution of a diagnosis and development of a comprehensive approach. J Perinatol 2015; 35:313-321. [PMID: 25811285 PMCID: PMC4414744 DOI: 10.1038/jp.2015.19] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/20/2015] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is the most common respiratory consequence of premature birth and contributes to significant short- and long-term morbidity, mortality and resource utilization. Initially defined as a radiographic, clinical and histopathological entity, the chronic lung disease known as BPD has evolved as obstetrical and neonatal care have improved the survival of lower gestational age infants. Now, definitions based on the need for supplementary oxygen at 28 days and/or 36 weeks provide a useful reference point in the neonatal intensive-care unit (NICU), but are no longer based on histopathological findings, and are neither designed to predict longer term respiratory consequences nor to study the evolution of a multifactorial disease. The aims of this review are to critically examine the evolution of the diagnosis of BPD and the challenges inherent to current classifications. We found that the increasing use of respiratory support strategies that administer ambient air without supplementary oxygen confounds oxygen-based definitions of BPD. Furthermore, lack of reproducible, genetic, biochemical and physiological biomarkers limits the ability to identify an impending BPD for early intervention, quantify disease severity for standardized classification and approaches and reliably predict the long-term outcomes. More comprehensive, multidisciplinary approaches to overcome these challenges involve longitudinal observation of extremely preterm infants, not only those with BPD, using genetic, environmental, physiological and clinical data as well as large databases of patient samples. The Prematurity and Respiratory Outcomes Program (PROP) will provide such a framework to address these challenges through high-resolution characterization of both NICU and post-NICU discharge outcomes.
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Davis SD, Ferkol TW, Rosenfeld M, Lee HS, Dell SD, Sagel SD, Milla C, Zariwala MA, Pittman JE, Shapiro AJ, Carson JL, Krischer JP, Hazucha MJ, Cooper ML, Knowles MR, Leigh MW. Clinical features of childhood primary ciliary dyskinesia by genotype and ultrastructural phenotype. Am J Respir Crit Care Med 2015; 191:316-24. [PMID: 25493340 DOI: 10.1164/rccm.201409-1672oc] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE The relationship between clinical phenotype of childhood primary ciliary dyskinesia (PCD) and ultrastructural defects and genotype is poorly defined. OBJECTIVES To delineate clinical features of childhood PCD and their associations with ultrastructural defects and genotype. METHODS A total of 118 participants younger than 19 years old with PCD were evaluated prospectively at six centers in North America using standardized procedures for diagnostic testing, spirometry, chest computed tomography, respiratory cultures, and clinical phenotyping. MEASUREMENTS AND MAIN RESULTS Clinical features included neonatal respiratory distress (82%), chronic cough (99%), and chronic nasal congestion (97%). There were no differences in clinical features or respiratory pathogens in subjects with outer dynein arm (ODA) defects (ODA alone; n = 54) and ODA plus inner dynein arm (IDA) defects (ODA + IDA; n = 18) versus subjects with IDA and central apparatus defects with microtubular disorganization (IDA/CA/MTD; n = 40). Median FEV1 was worse in the IDA/CA/MTD group (72% predicted) versus the combined ODA groups (92% predicted; P = 0.003). Median body mass index was lower in the IDA/CA/MTD group (46th percentile) versus the ODA groups (70th percentile; P = 0.003). For all 118 subjects, median number of lobes with bronchiectasis was three and alveolar consolidation was two. However, the 5- to 11-year-old IDA/CA/MTD group had more lobes of bronchiectasis (median, 5; P = 0.0008) and consolidation (median, 3; P = 0.0001) compared with the ODA groups (median, 3 and 2, respectively). Similar findings were observed when limited to participants with biallelic mutations. CONCLUSIONS Lung disease was heterogeneous across all ultrastructural and genotype groups, but worse in those with IDA/CA/MTD ultrastructural defects, most of whom had biallelic mutations in CCDC39 or CCDC40.
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Pryhuber GS, Maitre NL, Ballard RA, Cifelli D, Davis SD, Ellenberg JH, Greenberg JM, Kemp J, Mariani TJ, Panitch H, Ren C, Shaw P, Taussig LM, Hamvas A. Prematurity and respiratory outcomes program (PROP): study protocol of a prospective multicenter study of respiratory outcomes of preterm infants in the United States. BMC Pediatr 2015; 15:37. [PMID: 25886363 PMCID: PMC4407843 DOI: 10.1186/s12887-015-0346-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/11/2015] [Indexed: 12/17/2022] Open
Abstract
Background With improved survival rates, short- and long-term respiratory complications of premature birth are increasing, adding significantly to financial and health burdens in the United States. In response, in May 2010, the National Institutes of Health (NIH) and the National Heart, Lung, and Blood Institute (NHLBI) funded a 5-year $18.5 million research initiative to ultimately improve strategies for managing the respiratory complications of preterm and low birth weight infants. Using a collaborative, multi-disciplinary structure, the resulting Prematurity and Respiratory Outcomes Program (PROP) seeks to understand factors that correlate with future risk for respiratory morbidity. Methods/Design The PROP is an observational prospective cohort study performed by a consortium of six clinical centers (incorporating tertiary neonatal intensive care units [NICU] at 13 sites) and a data-coordinating center working in collaboration with the NHLBI. Each clinical center contributes subjects to the study, enrolling infants with gestational ages 23 0/7 to 28 6/7 weeks with an anticipated target of 750 survivors at 36 weeks post-menstrual age. In addition, each center brings specific areas of scientific focus to the Program. The primary study hypothesis is that in survivors of extreme prematurity specific biologic, physiologic and clinical data predicts respiratory morbidity between discharge and 1 year corrected age. Analytic statistical methodology includes model-based and non-model-based analyses, descriptive analyses and generalized linear mixed models. Discussion PROP incorporates aspects of NICU care to develop objective biomarkers and outcome measures of respiratory morbidity in the <29 week gestation population beyond just the NICU hospitalization, thereby leading to novel understanding of the nature and natural history of neonatal lung disease and of potential mechanistic and therapeutic targets in at-risk subjects. Trial registration Clinical Trials.gov NCT01435187. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0346-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gloria S Pryhuber
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Nathalie L Maitre
- Monroe Carrell Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Roberta A Ballard
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
| | - Denise Cifelli
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Stephanie D Davis
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Jonas H Ellenberg
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - James M Greenberg
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - James Kemp
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Thomas J Mariani
- Department of Pediatrics and Pediatric Molecular and Personalized Medicine Program, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Howard Panitch
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Clement Ren
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Pamela Shaw
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Lynn M Taussig
- Department of Pediatrics, University of Colorado, Provost's Office, University of Denver, Denver, CO, USA.
| | - Aaron Hamvas
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Sheikh SI, Long FR, Flucke R, Ryan-Wenger NA, Hayes D, McCoy KS. Changes in Pulmonary Function and Controlled Ventilation-High Resolution CT of Chest After Antibiotic Therapy in Infants and Young Children with Cystic Fibrosis. Lung 2015; 193:421-8. [PMID: 25762451 DOI: 10.1007/s00408-015-9706-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants with cystic fibrosis (CF) develop early progressive lung disease which may be asymptomatic. Infant pulmonary function tests (IPFT) and controlled ventilation-high resolution computed tomography (CV-HRCT) of chest can detect early asymptomatic lung disease. It is not well established that these objective measures can detect changes in lung disease after clinical interventions. OBJECTIVE The purpose of this study was to evaluate usefulness of IPFT and CV-HRCT to detect changes in lung disease after intravenous (IV) antibiotic therapy in infants with early CF-related lung disease. STUDY DESIGN IPFTs and CV-HRCT done before and after 2 weeks of IV antibiotics in infants at our institution over the last 12 years were compared. CV-HRCTs were compared using the modified Brody scoring system. RESULTS The sample included 21 infants, mean age 85.2 ± 47.6 weeks. Mean change in weight was 0.4 ± 0.38 kg (p = 0.001). Significant changes in IPFT included mean % predicted FEV(0.5) (+13.5 %, p = 0.043), mean %FEF(25-75) (+30.2 %, p = 0.008), mean %RV/TLC (-11.2 %, p = 0.008), and mean %FRC/TLC (-4.5 %, p = 0.001). Total Brody scores improved from a median of 10 to 5 (p < 0.001) as did mean scores for airway wall thickening (p = 0.050), air trapping (p < 0.001), and parenchymal opacities (p = 0.003). CONCLUSION IPFT and CV-HRCT can be used as objective measures of improvement in lung disease for infants with CF treated with antibiotics.
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Affiliation(s)
- Shahid I Sheikh
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,
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Tiddens HAWM, Puderbach M, Venegas JG, Ratjen F, Donaldson SH, Davis SD, Rowe SM, Sagel SD, Higgins M, Waltz DA. Novel outcome measures for clinical trials in cystic fibrosis. Pediatr Pulmonol 2015; 50:302-315. [PMID: 25641878 PMCID: PMC4365726 DOI: 10.1002/ppul.23146] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/20/2014] [Accepted: 11/02/2014] [Indexed: 12/25/2022]
Abstract
Cystic fibrosis (CF) is a common inherited condition caused by mutations in the gene encoding the CF transmembrane regulator protein. With increased understanding of the molecular mechanisms underlying CF and the development of new therapies there comes the need to develop new outcome measures to assess the disease, its progression and response to treatment. As there are limitations to the current endpoints accepted for regulatory purposes, a workshop to discuss novel endpoints for clinical trials in CF was held in Anaheim, California in November 2011. The pros and cons of novel outcome measures with potential utility for evaluation of novel treatments in CF were critically evaluated. The highlights of the 2011 workshop and subsequent advances in technologies and techniques that could be used to inform the development of clinical trial endpoints are summarized in this review. Pediatr Pulmonol. © 2014 The Authors. Pediatric Pulmonology published by Wiley Periodicals, Inc.
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Affiliation(s)
- Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology, Department of Radiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Michael Puderbach
- Department for Diagnostic and Interventional Radiology, Hufeland Klinikum, Bad Langensalza, Germany
| | - Jose G Venegas
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Felix Ratjen
- Department of Pediatrics, Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Scott H Donaldson
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Stephanie D Davis
- Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colorado
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Loeve M, Rosenow T, Gorbunova V, Hop WCJ, Tiddens HAWM, de Bruijne M. Reversibility of trapped air on chest computed tomography in cystic fibrosis patients. Eur J Radiol 2015; 84:1184-90. [PMID: 25840703 DOI: 10.1016/j.ejrad.2015.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate changes in trapped air volume and distribution over time and compare computed tomography (CT) with pulmonary function tests for determining trapped air. METHODS Thirty children contributed two CTs and pulmonary function tests over 2 years. Localized changes in trapped air on CT were assessed using image analysis software, by deforming the CT at timepoint 2 to match timepoint 1, and measuring the volume of stable (TAstable), disappeared (TAdisappeared) and new (TAnew) trapped air as a proportion of total lung volume. We used the difference between total lung capacity measured by plethysmography and helium dilution, residual volume to total lung capacity ratio, forced expiratory flow at 75% of vital capacity, and maximum mid-expiratory flow as pulmonary function test markers of trapped air. Statistical analysis included Wilcoxon's signed rank test and Spearman correlation coefficients. RESULTS Median (range) age at baseline was 11.9 (5-17) years. Median (range) of trapped air was 9.5 (2-33)% at timepoint 1 and 9.0 (0-25)% at timepoint 2 (p=0.49). Median (range) TAstable, TAdisappeared and TAnew were respectively 3.0 (0-12)%, 5.0 (1-22)% and 7.0 (0-20)%. Trapped air on CT correlated statistically significantly with all pulmonary function measures (p<0.01), other than residual volume to total lung capacity ratio (p=0.37). CONCLUSION Trapped air on CT did not significantly progress over 2 years, may have a substantial stable component, and is significantly correlated with pulmonary function markers.
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Affiliation(s)
- Martine Loeve
- Department of Pediatric Pulmonology & Allergology, Erasmus MC-Sophia Children's Hospital, The Netherlands; Department of Radiology, Erasmus MC, The Netherlands
| | - Tim Rosenow
- Department of Pediatric Pulmonology & Allergology, Erasmus MC-Sophia Children's Hospital, The Netherlands; School of Paediatrics and Child Health Research, The University of Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Australia
| | | | - Wim C J Hop
- Department of Biostatistics, Erasmus MC, The Netherlands
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology & Allergology, Erasmus MC-Sophia Children's Hospital, The Netherlands; Department of Radiology, Erasmus MC, The Netherlands.
| | - Marleen de Bruijne
- Department of Radiology, Erasmus MC, The Netherlands; Department of Computer Science, University of Copenhagen, Denmark; Department of Medical Informatics, Erasmus MC, The Netherlands
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Kopp BT, Sarzynski L, Khalfoun S, Hayes D, Thompson R, Nicholson L, Long F, Castile R, Groner J. Detrimental effects of secondhand smoke exposure on infants with cystic fibrosis. Pediatr Pulmonol 2015; 50:25-34. [PMID: 24610820 DOI: 10.1002/ppul.23016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/30/2014] [Indexed: 11/06/2022]
Abstract
RATIONALE Secondhand smoke (SHS) has deleterious respiratory, immune, and nutritional effects in children, but there is little data regarding the effects of SHS exposure in infants with cystic fibrosis (CF). METHODS A retrospective chart review was undertaken from 2008 to 2012 of 75 infants with CF. Growth, lung function, Chest CT imaging, and microbiologic characteristics were compared between 4 and 12 months for SHS and non-SHS exposed patients. RESULTS SHS exposed infants with CF had decreased growth between 4 and 12 months compared to non-SHS exposed infants. SHS exposure was associated with increased bronchodilator responsiveness and air trapping, but no other lung function or radiologic differences. SHS exposure was also associated with increased methicillin resistant Staphylococcus aureus (MRSA) and anaerobic growth on respiratory culture. There was no difference in Pseudomonas aeruginosa between groups. There were no differences in antibiotic use or hospitalizations between the groups. CONCLUSIONS SHS exposure in CF infants is associated with diminished growth, increased air trapping and bronchodilator responsiveness, and propensity to culture MRSA and facultative anaerobic bacteria, suggesting the need for early, aggressive parental smoking cessation interventions to prevent SHS exposure complications.
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Affiliation(s)
- Benjamin T Kopp
- Section of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, Ohio; Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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Ren CL, Robinson P, Ranganathan S. Chloral hydrate sedation for infant pulmonary function testing. Pediatr Pulmonol 2014; 49:1251-2. [PMID: 24574186 PMCID: PMC4143482 DOI: 10.1002/ppul.23012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 01/10/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Clement L Ren
- Department of Pediatrics, University of Rochester, Rochester, New York
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Ramsey KA, Ranganathan S, Park J, Skoric B, Adams AM, Simpson SJ, Robins-Browne RM, Franklin PJ, de Klerk NH, Sly PD, Stick SM, Hall GL. Early Respiratory Infection Is Associated with Reduced Spirometry in Children with Cystic Fibrosis. Am J Respir Crit Care Med 2014; 190:1111-6. [DOI: 10.1164/rccm.201407-1277oc] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Goralski JL, Davis SD. Breathing easier: addressing the challenges of aerosolizing medications to infants and preschoolers. Respir Med 2014; 108:1069-74. [PMID: 25012949 DOI: 10.1016/j.rmed.2014.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/03/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
An increasing number of patients are dependent on aerosolized therapy to manage pulmonary diseases, including asthma, cystic fibrosis, and pulmonary arterial hypertension. An aerosol therapy is only useful if it can be appropriately and consistently delivered in the desired dose to the lower respiratory tract. Many factors affect this deposition in young children, including anatomical and physiologic differences between adults and children, patient-mask interface issues, the challenge of administering medication to uncooperative children, and behavioral adherence. Moreover, the techniques used to assess aerosol delivery to pediatric patients need to be carefully evaluated as new therapies and drug-device combinations are tested. In this review, we will address some of the challenges of delivering aerosolized medications to pediatric patients.
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Affiliation(s)
- Jennifer L Goralski
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Pediatric Pulmonology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Stephanie D Davis
- James Whitcomb Riley Hospital for Children, Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Ramsey KA, Ranganathan S. Interpretation of lung function in infants and young children with cystic fibrosis. Respirology 2014; 19:792-9. [PMID: 24948040 DOI: 10.1111/resp.12329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 11/29/2022]
Abstract
The last decade has seen a significant advance in understanding about early lung disease in cystic fibrosis (CF). As studies that have measured lung function in preschool years are conducted in association with surveillance of infection, inflammation and early structural changes, and emerging longitudinal data become available, a better insight into the very early onset and nature of such lung disease is emerging. Interventions during the preschool years are increasingly viewed as being crucial to delaying and minimizing disease progression as this is the most important period of postnatal life in terms of lung development and airway remodelling. Lung function measurement in CF is potentially an important assessment tool and is used in routine clinical practice in several centres already. Results of studies from lung function tests that, on the basis of their underpinning physiology, are viewed as being best suited currently for the early detection of lung disease in CF are reviewed.
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Affiliation(s)
- Kathryn A Ramsey
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
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Abstract
Assessments of pulmonary function play an integral part in the clinical management of school age children as well as providing objective outcome measures in clinical and epidemiological research studies. Pulmonary function tests (PFTs) can also be undertaken in sleeping infants and in awake young children from 3 years of age. However, the clinical utility of such assessments, which are generally confined to specialist centres, has yet to be established. Whether requesting or undertaking paediatric PFTs, or simply reading about how these tests have been applied in research studies, it is essential to question whether results have been interpreted in a meaningful way. This review summarises some of the issues that need to be considered, including: why the tests are being performed; which tests are most likely to detect the suspected pathophysiology; how often such tests should be repeated; whether results are likely to be reliable (in terms of data quality, repeatability and the availability of suitable reference equations with which to distinguish the effects of disease from those of growth and development), and whether the selected tests are likely to be feasible in the individual child or study group under investigation.
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Hayes D, Naguib A, Kirkby S, Galantowicz M, McConnell PI, Baker PB, Kopp BT, Lloyd EA, Astor TL. Comprehensive evaluation of lung allograft function in infants after lung and heart-lung transplantation. J Heart Lung Transplant 2014; 33:507-13. [DOI: 10.1016/j.healun.2014.01.867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/17/2014] [Accepted: 01/22/2014] [Indexed: 10/25/2022] Open
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Peterson-Carmichael SL, Rosenfeld M, Ascher SB, Hornik CP, Arets HGM, Davis SD, Hall GL. Survey of clinical infant lung function testing practices. Pediatr Pulmonol 2014; 49:126-31. [PMID: 23765632 DOI: 10.1002/ppul.22807] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/16/2013] [Accepted: 03/14/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data supporting the clinical use of infant lung function (ILF) tests are limited making the interpretation of clinical ILF measures difficult. OBJECTIVES To evaluate current ILF testing practices and to survey users regarding the indications, limitations and perceived clinical benefits of ILF testing. METHODS We created a 26-item survey hosted on the European Respiratory Society (ERS) website between January and May 2010. Notifications were sent to members of the ERS, American Thoracic Society and the Asian Pacific Society of Respirology. Responses were sought from ILF laboratory directors and pediatric respirologists. The survey assessed the clinical indications, patient populations, equipment and reference data used, and perceived limitations of ILF testing. RESULTS We received 148 responses with 98 respondents having ILF equipment and performing testing in a clinical capacity. Centers in North America were less likely to perform ≥50 studies/year than centers in Europe or other continents (13% vs. 41%). Most respondents used ILF data to either "start a new therapy" (78%) or "help decide about initiation of further diagnostic workup such as bronchoscopy, chest CT or serological testing" (69%). Factors reported as limiting clinical ILF testing were need for sedation, uncertainty regarding clinical impact of study results and time intensive nature of the study. CONCLUSIONS Clinical practices associated with ILF testing vary significantly; centers that perform more studies are more likely to use the results for clinical purposes and decision making. The future of ILF testing is uncertain in the face of the limitations perceived by the survey respondents.
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Goralski JL, Davis SD. Challenges and limitations of testing efficacy of aerosol device delivery in young children. J Aerosol Med Pulm Drug Deliv 2014; 27:264-71. [PMID: 24476048 DOI: 10.1089/jamp.2013.1097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An increasing number of medical conditions are chronically or acutely managed with some form of aerosolized therapy. Due to the benefit of directly administering medications to the intended site of action, there is great interest in evaluating treatments for aerosol use. One of the major challenges in selecting and testing new drug-device combinations in children is the uncertainty regarding the appropriate outcome measure to choose. In studies involving adult patients, typically exacerbations of disease or airflow obstruction are assessed as endpoints in drug trials or device assessment. However, in young children, choosing endpoints to assess efficacy is difficult due to the potential lack of sensitive, noninvasive endpoints that are easily performed across sites. In this review, we discuss the challenges and limitations of selecting clinical endpoints for drug-device trials in the youngest population, with a focus on novel emerging technologies. This article provides an overview of preschool and infant pulmonary function testing, multiple-breath washout, imaging techniques including computed tomography and magnetic resonance imaging, flexible bronchoscopy in children, mucociliary clearance scans, and exhaled breath condensate.
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Affiliation(s)
- Jennifer L Goralski
- 1 Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill , Chapel Hill, NC
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Kent L, Reix P, Innes JA, Zielen S, Le Bourgeois M, Braggion C, Lever S, Arets HGM, Brownlee K, Bradley JM, Bayfield K, O'Neill K, Savi D, Bilton D, Lindblad A, Davies JC, Sermet I, De Boeck K. Lung clearance index: evidence for use in clinical trials in cystic fibrosis. J Cyst Fibros 2013; 13:123-38. [PMID: 24315208 DOI: 10.1016/j.jcf.2013.09.005] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 02/09/2023]
Abstract
The ECFS-CTN Standardisation Committee has undertaken this review of lung clearance index as part of the group's work on evaluation of clinical endpoints with regard to their use in multicentre clinical trials in CF. The aims were 1) to review the literature on reliability, validity and responsiveness of LCI in patients with CF, 2) to gain consensus of the group on feasibility of LCI and 3) to gain consensus on answers to key questions regarding the promotion of LCI to surrogate endpoint status. It was concluded that LCI has an attractive feasibility and clinimetric properties profile and is particularly indicated for multicentre trials in young children with CF and patients with early or mild CF lung disease. This is the first article to collate the literature in this manner and support the use of LCI in clinical trials in CF.
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Affiliation(s)
- L Kent
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute for Nursing and Health Research, University of Ulster, Newtownabbey, UK; Regional Cystic Fibrosis Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - P Reix
- Centre de Référence de la Mucoviscidose, Hospices Civils de Lyon, Lyon, France
| | - J A Innes
- Scottish Adult Cystic Fibrosis Service, Western General Hospital, Edinburgh, UK; Molecular and Clinical Medicine, University of Edinburgh, UK
| | - S Zielen
- Department of Paediatrics, J.W. Goethe-Universität Frankfurt, Germany
| | - M Le Bourgeois
- Centre de Référence de la Mucoviscidose, Hôpital Necker-Enfants Malades, Paris, France
| | - C Braggion
- Cystic Fibrosis Center, Pediatric Department, Meyer Children's Hospital, Florence, Italy
| | - S Lever
- Erasmus MC, Rotterdam, The Netherlands
| | - H G M Arets
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - K Brownlee
- Children's Cystic Fibrosis Centre, Leeds Teaching Hospitals, Leeds, UK
| | - J M Bradley
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute for Nursing and Health Research, University of Ulster, Newtownabbey, UK; Regional Cystic Fibrosis Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - K Bayfield
- Department of Gene Therapy, Imperial College London, UK
| | - K O'Neill
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - D Savi
- Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - D Bilton
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - A Lindblad
- Gothenburg CF Centre, Queen Silvia Children's Hospital, Göteborg, Sweden
| | - J C Davies
- Department of Gene Therapy, Imperial College London, UK; Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - I Sermet
- Centre de Référence de la Mucoviscidose, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Paris, France
| | - K De Boeck
- Pediatric Pulmonology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
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An official American Thoracic Society workshop report: optimal lung function tests for monitoring cystic fibrosis, bronchopulmonary dysplasia, and recurrent wheezing in children less than 6 years of age. Ann Am Thorac Soc 2013; 10:S1-S11. [PMID: 23607855 DOI: 10.1513/annalsats.201301-017st] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although pulmonary function testing plays a key role in the diagnosis and management of chronic pulmonary conditions in children under 6 years of age, objective physiologic assessment is limited in the clinical care of infants and children less than 6 years old, due to the challenges of measuring lung function in this age range. Ongoing research in lung function testing in infants, toddlers, and preschoolers has resulted in techniques that show promise as safe, feasible, and potentially clinically useful tests. Official American Thoracic Society workshops were convened in 2009 and 2010 to review six lung function tests based on a comprehensive review of the literature (infant raised-volume rapid thoracic compression and plethysmography, preschool spirometry, specific airway resistance, forced oscillation, the interrupter technique, and multiple-breath washout). In these proceedings, the current state of the art for each of these tests is reviewed as it applies to the clinical management of infants and children under 6 years of age with cystic fibrosis, bronchopulmonary dysplasia, and recurrent wheeze, using a standardized format that allows easy comparison between the measures. Although insufficient evidence exists to recommend incorporation of these tests into the routine diagnostic evaluation and clinical monitoring of infants and young children with cystic fibrosis, bronchopulmonary dysplasia, or recurrent wheeze, they may be valuable tools with which to address specific concerns, such as ongoing symptoms or monitoring response to treatment, and as outcome measures in clinical research studies.
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Kerby GS, Wagner BD, Popler J, Hay TC, Kopecky C, Wilcox SL, Quinones RR, Giller RH, Accurso FJ, Deterding RR. Abnormal infant pulmonary function in young children with neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2013; 48:1008-15. [PMID: 23169677 DOI: 10.1002/ppul.22718] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 08/27/2012] [Indexed: 11/06/2022]
Abstract
RATIONALE Lung function in children with neuroendocrine cell hyperplasia of infancy (NEHI) and correlations with future clinical outcomes are needed to guide clinical management. OBJECTIVE To compare results of infant pulmonary function tests (IPFTs) in children with NEHI to disease control (DC) subjects and to correlate NEHI IPFTs with future outcomes. METHODS We performed a retrospective, single center study of IPFT in subjects diagnosed by lung biopsy (NEHI) or clinically (NEHI syndrome) and in DC subjects evaluated for cancer or pre-hematopoietic stem cell transplantation (HSCT). Raised volume rapid thoracoabdominal compression (RVRTC) and plethysmography were performed on all infants and evaluated for quality. Standard spirometry measures, room air oxygen saturations (RA O2 sat), and weight percentiles were collected during follow up. MEASUREMENTS AND MAIN RESULTS Fifty-seven IPFTs were performed in 15 NEHI, 22 NEHI syndrome, and 20 DC subjects. RVRTC and FRC measurements were obtained in 85% or more of subjects in all groups. Significant airflow limitation (FEV0.5 P-value ≤ 0.01) and air trapping (FRC P-value ≤ 0.01) were seen in NEHI and NEHI syndrome subjects compared to DCs. No significant correlations were found between IPFT, oxygen use, RA O2 sat, and weight at the time of the IPFTs. Initial FEV0.5 and FRC z-scores correlated with RA O2 sat (r = 0.60 and -0.49) at short-term follow up (6-12 months). Most measurements of RVRTC correlated with FEV1 (n = 5) measured 4-5 years later (r > 0.50). CONCLUSIONS IPFTs in NEHI subjects are feasible, demonstrate significant obstruction and air trapping, and correlate with future RA O2 sat and FEV1 . IPFTs may provide valuable clinical information when caring for NEHI patients. Pediatr Pulmonol. 2013; 48:1008-1015. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Gwendolyn S Kerby
- Department of Pediatrics, Section of Pulmonary Medicine, University of Colorado School of Medicine and The Breathing Institute, Children's Hospital Colorado, Aurora, Colorado
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Abstract
PURPOSE OF REVIEW The field of cystic fibrosis (CF) is changing dramatically as the scientific knowledge accumulated since the cloning of the cystic fibrosis transmembrane conductance regulator (CFTR) gene is being translated into effective therapies to correct the basic defect and provide better disease models and in-depth understanding of the basic mechanisms of disease. RECENT FINDINGS This review focuses on three main aspects of the recent advances in the field: understanding the lung disease pathophysiology (in particular, the early events that condition its onset), better definition of the complex microbiology of the CF airway, and therapeutic developments. Although the most recently developed therapies, whether approved or under study, do not constitute a definitive cure, the benefit to patients is already becoming clearly apparent. SUMMARY As the field continues to change rapidly and new therapies are being identified, CF has become a paradigm for the application of concepts such as translational medicine, genomic medicine, and personalized care, with measurable clinical benefit for the patients affected by this disease.
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Simpson SJ, Mott LS, Esther CR, Stick SM, Hall GL. Novel end points for clinical trials in young children with cystic fibrosis. Expert Rev Respir Med 2013; 7:231-43. [PMID: 23734646 PMCID: PMC5033038 DOI: 10.1586/ers.13.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cystic fibrosis (CF) lung disease commences early in the disease progression and is the most common cause of mortality. While new CF disease-modifying agents are currently undergoing clinical trial evaluation, the implementation of such trials in young children is limited by the lack of age-appropriate clinical trial end points. Advances in infant and preschool lung function testing, imaging of the chest and the development of biochemical biomarkers have led to increased possibility of quantifying mild lung disease in young children with CF and objectively monitoring disease progression over the course of an intervention. Despite this, further standardization and development of these techniques is required to provide robust objective measures for clinical trials in this age group.
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Affiliation(s)
- Shannon J Simpson
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia
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Rosenfeld M, Farrell PM, Kloster M, Swanson JO, Vu T, Brumback L, Acton JD, Castile RG, Colin AA, Conrad CK, Hart MA, Kerby GS, Hiatt PW, Mogayzel PJ, Johnson RC, Davis SD. Association of lung function, chest radiographs and clinical features in infants with cystic fibrosis. Eur Respir J 2013; 42:1545-52. [PMID: 23722613 DOI: 10.1183/09031936.00138412] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The optimal strategy for monitoring cystic fibrosis lung disease in infancy remains unclear. Our objective was to describe longitudinal associations between infant pulmonary function tests, chest radiograph scores and other characteristics. Cystic fibrosis patients aged ≤24 months were enrolled in a 10-centre study evaluating infant pulmonary function tests four times over a year. Chest radiographs ∼1 year apart were scored using the Wisconsin and Brasfield systems. Associations of infant pulmonary function tests with clinical characteristics were evaluated with mixed effects models. The 100 participants contributed 246 acceptable flow/volume (forced expiratory volume in 0.5 s (FEV0.5) and forced expiratory flow at 75% of the forced vital capacity (FEF75%)), 303 functional residual capacity measurements and 171 chest radiographs. Both Brasfield and Wisconsin chest radiograph scores worsened significantly over the 1-year interval. Worse Wisconsin chest radiograph scores and Staphylococcus aureus were both associated with hyperinflation (significantly increased functional residual capacity), but not with diminished FEV0.5 or FEF75%. Parent-reported cough was associated with significantly diminished forced expiratory flow at 75% but not with hyperinflation. In this infant cohort in whom we previously reported worsening in average lung function, chest radiograph scores also worsened over a year. The significant associations detected between both Wisconsin chest radiograph score and S. aureus and hyperinflation, as well as between cough and diminished flows, reinforce the ability of infant pulmonary function tests and chest radiographs to detect early cystic fibrosis lung disease.
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