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Charon L, Launois C, Perotin JM, Ravoninjatovo B, Mulette P, Ancel J, Guillard T, Muggeo A, Dormoy V, Griffon M, Carré S, Lebargy F, Deslée G, Dury S. Current cough and sputum assessed by the cough and sputum assessment-questionnaire (CASA-Q) is associated with quality of life impairment in cystic fibrosis. BMC Pulm Med 2023; 23:457. [PMID: 37990322 PMCID: PMC10664648 DOI: 10.1186/s12890-023-02701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Cough and sputum are major symptoms in cystic fibrosis (CF) that contribute to the impairment of quality of life. METHODS This prospective single centre cross-sectional pilot study aimed to evaluate the results of a self-administered questionnaire assessing cough and sputum symptoms (2 domains), and their impact (2 domains) on daily activities in the previous week, named the Cough and Sputum Assessment Questionnaire (CASA-Q) in CF adult patients at stable state, and to analyse associations with clinical, functional, microbiological, radiological data, and two quality of life scales: the Cystic Fibrosis Questionnaire Revised (CFQ-R) and the Saint George Respiratory Questionnaire (SGRQ). RESULTS Forty-eight patients were included in this analysis (69% men; median age of 27.8 ± 8.1 years; median body mass index of 21.8 + 3.3 kg/m²; mean FEV1 of 64 ± 30% of the predicted value). The mean values of the CASA-Q domains were 58 ± 23 for cough symptoms, 77 ± 24 for cough impact, 62 ± 25 for sputum symptoms and 84 ± 21 for sputum impact. Impairment in CASA-Q cough and sputum domains was associated with dyspnea mMRC scale (p < 0.005 for all 4 domains of CASA-Q) and exacerbations in the previous year (p < 0.05 for CASA-Q symptoms domains). We also found correlations between all domains of the CASA-Q and quality of life questionnaires including SGRQ (p < 0.001) and to a lesser extend CFQ-R. We identified a clinical phenotype (female gender, ΔF508 heterozygous mutation, dyspnea mMRC scale) associated with an impairment of CASA-Q score and quality of life using a 2-step cluster analysis. CONCLUSIONS CASA-Q allows the assessment of cough and sputum in CF adult patients and is associated with quality of life impairment. This simple easy-to-use tool could be used in routine clinical practice and in clinical studies to assess cough and sputum in CF patients. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (NCT02924818, first posted on 5th October 2016).
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Affiliation(s)
- Lucie Charon
- Service des Maladies Respiratoires et Allergiques, CHU de Reims, Reims, France
| | - Claire Launois
- Service des Maladies Respiratoires et Allergiques, CHU de Reims, Reims, France
| | - Jeanne-Marie Perotin
- Service des Maladies Respiratoires et Allergiques, Université de Reims Champagne-Ardenne, INSERM, CHU de Reims, P3Cell, U 1250, Reims, France
| | - Bruno Ravoninjatovo
- Service des Maladies Respiratoires et Allergiques, CHU de Reims, Reims, France
| | - Pauline Mulette
- Service des Maladies Respiratoires et Allergiques, CHU de Reims, Reims, France
| | - Julien Ancel
- Service des Maladies Respiratoires et Allergiques, Université de Reims Champagne-Ardenne, INSERM, CHU de Reims, P3Cell, U 1250, Reims, France
| | - Thomas Guillard
- Laboratoire de Bactériologie-Virologie-Hygiène hospitalière- Parasitologie-Mycologie, Université de Reims Champagne-Ardenne, INSERM, CHU de Reims, P3Cell, Reims, U 1250, France
| | - Anaëlle Muggeo
- Laboratoire de Bactériologie-Virologie-Hygiène hospitalière- Parasitologie-Mycologie, Université de Reims Champagne-Ardenne, INSERM, CHU de Reims, P3Cell, Reims, U 1250, France
| | - Valérian Dormoy
- INSERM UMRS 1250, Université de Reims Champagne-Ardenne, Reims, France
| | - Muriel Griffon
- Service des Maladies Respiratoires et Allergiques, CHU de Reims, Reims, France
| | - Sophie Carré
- Service des Maladies Respiratoires et Allergiques, CHU de Reims, Reims, France
| | - François Lebargy
- Service des Maladies Respiratoires et Allergiques, Université de Reims Champagne-Ardenne, EA7509 IRMAIC, CHU de Reims, Reims, France
| | - Gaëtan Deslée
- Service des Maladies Respiratoires et Allergiques, Université de Reims Champagne-Ardenne, INSERM, CHU de Reims, P3Cell, U 1250, Reims, France
| | - Sandra Dury
- Service des Maladies Respiratoires et Allergiques, CHU de Reims, Reims, France.
- EA7509 IRMAIC, Université de Reims Champagne-Ardenne, Reims, France.
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Glasscoe C, Hope HF, Lancaster GA, McCray G, West K, Patel L, Patel T, Hill J, Quittner AL, Southern KW. Development and preliminary validation of the challenges of living with cystic fibrosis (CLCF) questionnaire: a 46-item measure of treatment burden for parent/carers of children with CF. Psychol Health 2023; 38:1309-1344. [PMID: 35259034 DOI: 10.1080/08870446.2021.2013483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/29/2021] [Accepted: 11/28/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Treatments for cystic fibrosis (CF) are complex, labour-intensive, and perceived as highly burdensome by caregivers of children with CF. An instrument assessing burden of care is needed. DESIGN A stepwise, qualitative design was used to create the CLCF with caregiver focus groups, participant researchers, a multidisciplinary professional panel, and cognitive interviews. MAIN OUTCOME MEASURES Preliminary psychometric analyses evaluated the reliability and convergent validity of the CLCF scores. Cronbach's alpha assessed internal consistency and t-tests examined test-retest reliability. Correlations measured convergence between the Treatment Burden scale of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) and the CLCF. Discriminant validity was assessed by comparing CLCF scores in one vs two-parent families, across ages, and in children with vs without Pseudomonas aeruginosa (PA). RESULTS Six Challenge subscales emerged from the qualitative data and the professional panel constructed a scoresheet estimating the Time and Effort required for treatments. Internal consistency and test-retest reliability were adequate. Good convergence was found between the Total Challenge score and Treatment Burden on the CFQ-R (r=-0.49, p = 0.02, n = 31). A recent PA infection signalled higher Total Challenge for caregivers (F(23)11.72, p = 0.002). CONCLUSIONS The CLCF, developed in partnership with parents/caregivers and CF professionals, is a timely, disease-specific burden measure for clinical research.
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Affiliation(s)
- Claire Glasscoe
- Institute of Translational Medicine, Department of Women's & Children's Health, University of Liverpool, Liverpool, UK
| | - Holly F Hope
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | | | | | - Kiri West
- DMOPS (Movement Disorders), Liverpool University Hospitals NHS Foundation Trust (Aintree site), Liverpool, UK
| | - Latifa Patel
- Respiratory Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Tulsi Patel
- Evelina London Children's Hospital, London, UK
| | - Jonathan Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Kevin W Southern
- Institute of Translational Medicine, Department of Women's & Children's Health, University of Liverpool, Liverpool, UK
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Smith S, Calthorpe R, Herbert S, Smyth AR. Digital technology for monitoring adherence to inhaled therapies in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 2:CD013733. [PMID: 36734528 PMCID: PMC9896904 DOI: 10.1002/14651858.cd013733.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Improved understanding and treatment of cystic fibrosis (CF) has led to longer life expectancy, which is accompanied by an increasingly complex regimen of treatments. Suboptimal adherence to the treatment plan, in the context of respiratory disease, has been found to be associated with poorer health outcomes. With digital technology being more accessible, it can be used to monitor adherence to inhaled therapies via chipped nebulisers, mobile phone apps and web-based platforms. This technology can allow monitoring of adherence as well as clinical outcomes, and allow feedback to both the person with CF and their healthcare team. OBJECTIVES To assess the effects of using digital technology to monitor adherence to inhaled therapies and health status in adults and children with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 28 October 2021. We also searched Embase and three clinical trial registries and checked references of included studies. Date of last search: 9 November 2021. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) looking at the effects of a digital technology for monitoring adherence of children and adults with CF to inhaled therapies. DATA COLLECTION AND ANALYSIS Two review authors screened the search results for studies eligible for inclusion in the review and extracted their data. We used Risk of Bias 2 for assessing study quality. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS We included two studies in our review, with 628 participants aged five to 41 years. There was one study each for two different comparisons. Nebuliser target inhalation mode versus standard inhalation mode The included parallel study was carried out over 10 weeks after a run-in period of four to six weeks. The study compared the effects of a digitally enhanced inhalation mode (target inhalation mode) for nebulised antibiotics compared to standard mode in children attending a regional CF clinic in the United Kingdom. The study's primary outcome was the time taken to complete the inhaled treatment, but investigators also reported on adherence to therapy. The results showed that there may be an improvement in adherence with the target inhalation mode when this intervention is used (mean difference (MD) 24.0%, 95% confidence interval (CI) 2.95 to 45.05; low-certainty evidence). The target inhalation mode may make little or no difference to forced expiratory volume in one second (FEV1) % predicted (MD 1.00 % predicted, 95% CI -9.37 to 11.37; low-certainty evidence). The study did not report on treatment burden, quality of life (QoL) or pulmonary exacerbations. eNebuliser with digital support versus eNebuliser without support One large multicentre RCT monitored adherence via data-tracking nebulisers. The intervention group also receiving access to an online web-based platform, CFHealthHub, which offered tailored, flexible support from the study interventionist as well as access to their adherence data, educational and problem-solving information throughout the 12-month trial period. We graded all evidence as moderate certainty. Compared to usual care, the digital intervention probably improves adherence to inhaled therapy (MD 18%, 95% CI 12.90 to 23.10); probably leads to slightly reduced treatment burden (MD 5.1, 95% CI 1.79 to 8.41); and may lead to slightly improved FEV1 % predicted (MD 3.70, 95% CI -0.23 to 7.63). There is probably little or no difference in the incidence of pulmonary exacerbations or QoL between the two groups. AUTHORS' CONCLUSIONS Digital monitoring plus tailored support via an online platform probably improves adherence to inhaled therapies and reduces treatment burden (but without a corresponding change in QoL) in the medium term (low- and moderate-certainty evidence). In a shorter time frame, technological enhancement of inhaling antibiotics may improve adherence to treatment (low-certainty evidence). There may be little or no effect on lung function with either intervention, and online monitoring probably makes no difference to pulmonary exacerbations. Future research should assess the effect of digital technology on adherence in both children and adults. Consideration of adherence to the total treatment regimen is also important, as an improvement in adherence to inhaled therapies could come at the cost of adherence to other parts of the treatment regimen.
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Affiliation(s)
- Sherie Smith
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Sophie Herbert
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan R Smyth
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Gursli S, Quittner A, Jahnsen RB, Skrede B, Stuge B, Bakkeheim E. Airway clearance physiotherapy and health-related quality of life in cystic fibrosis. PLoS One 2022; 17:e0276310. [PMID: 36256673 PMCID: PMC9578613 DOI: 10.1371/journal.pone.0276310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/03/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Airway clearance physiotherapy is recommended in cystic fibrosis, but limited evidence exists to suggest how much treatment is enough. As a secondary analysis of a prior study investigating the safety, efficacy, and participants' perceptions of a novel airway clearance technique, specific cough technique (SCT) compared to forced expiration technique (FET), we aimed to evaluate whether the intervention was associated with changes in health-related quality of life (HRQoL). METHODS We conducted randomised, controlled individual trials with six adults (N-of-1 RCTs). Each trial included eight weeks of treatment, twice a week, using saline inhalation in horizontal positions, one with SCT and one with FET, in random order. Efficacy was measured by sputum wet weight (g) after each session. Perceived usefulness and preference were self-reported at the end of the study. Lung function was assessed at baseline and at the end of study. HRQoL was measured using the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (week 1) and at completion of the study (week 8). Individual HRQoL scores (0-100) were coded and analysed using CFQ-R Software Program, version 2.0. RESULTS Patient-reported outcomes were completed by all subjects. Individual CFQ-R-Respiratory Symptoms Scores (CFQ-R-RSS) showed a positive change, meeting the minimal important difference (MID) ≥ 4 points in five participants and a negative change in one individual. A strong correlation (r = 0.94 (p<0.01) was found between total sputum weight (g) and the positive changes in CFQ-R-RSS, and between changes in lung function and CFQ-R-RSS (r = 0.84 (p = 0.04). CONCLUSION The airway clearance intervention was associated with clinically meaningful changes in patient-reported symptoms on the CFQ-R in the majority of the participants. This finding warrants further investigation regarding treatment, duration and frequency. A long-term study may reveal beneficial effects on other clinically meaningful endpoints, such as pulmonary exacerbations, high-resolution computed tomography scores and HRQoL. TRIAL REGISTRATION The study was registered in ClinicalTrials.gov, under the number NCT0 1266473.
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Affiliation(s)
- Sandra Gursli
- National Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Alexandra Quittner
- Miami Children’s Research Institute, Miami, Florida, United States of America
| | - Reidun Birgitta Jahnsen
- Department of Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, CHARM, University of Oslo, Oslo, Norway
| | - Bjørn Skrede
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| | - Britt Stuge
- Division of Orthopaedic Surgery, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Egil Bakkeheim
- National Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
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Evaluation of the quality of life and associated factors of a group of children and adolescents with cystic fibrosis in the northern region of Portugal: a cross-sectional pilot study. Porto Biomed J 2022; 7:e194. [DOI: 10.1097/j.pbj.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
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Smith S, Rowbotham NJ, Edwards CT. Short-acting inhaled bronchodilators for cystic fibrosis. Cochrane Database Syst Rev 2022; 6:CD013666. [PMID: 35749226 PMCID: PMC9231652 DOI: 10.1002/14651858.cd013666.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Respiratory disease is the main cause of morbidity and mortality in cystic fibrosis (CF), and many different therapies are used by people with CF in the management of respiratory problems. Bronchodilator therapy is used to relieve symptoms of shortness of breath and to open the airways to allow clearance of mucus. Despite the widespread use of inhaled bronchodilators in CF, there is little objective evidence of their efficacy. A Cochrane Review looking at both short- and long-acting inhaled bronchodilators for CF was withdrawn from the Cochrane Library in 2016. That review has been replaced by two separate Cochrane Reviews: one on long-acting inhaled bronchodilators for CF, and this review on short-acting inhaled bronchodilators for CF. For this review 'inhaled' includes the use of pressurised metered dose inhalers (MDIs), with or without a spacer, dry powder devices and nebulisers. OBJECTIVES To evaluate short-acting inhaled bronchodilators in children and adults with CF in terms of clinical outcomes and safety. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books on 28 March 2022 and searched trial registries for any new or ongoing trials on 12 April 2022. We also searched the reference lists of relevant articles and reviews. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) or quasi-RCTs that looked at the effect of any short-acting inhaled bronchodilator delivered by any device, at any dose, at any frequency and for any duration compared to either placebo or another short-acting inhaled bronchodilator in people with CF. We screened references as per standard Cochrane methodology. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed risk of bias using the Cochrane RoB 1 tool. Where we were not able to enter data into our analyses we reported results directly from the papers. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 11 trials from our systematic search, with 191 participants meeting our inclusion criteria; three of these trials had three treatment arms. Eight trials compared short-acting inhaled beta-2 agonists to placebo and four trials compared short-acting inhaled muscarinic antagonists to placebo. Three trials compared short-acting inhaled beta-2 agonists to short-acting inhaled muscarinic antagonists. All were cross-over trials with only small numbers of participants. We were only able to enter data into the analysis from three trials comparing short-acting inhaled beta-2 agonists to placebo. Short-acting inhaled beta-2 agonists versus placebo All eight trials (six single-dose trials and two longer-term trials) reporting on this comparison reported on forced expiratory volume in 1 second (FEV1), either as per cent predicted (% predicted) or L. We were able to combine the data from two trials in a meta-analysis which showed a greater per cent change from baseline in FEV1 L after beta-2 agonists compared to placebo (mean difference (MD) 6.95%, 95% confidence interval (CI) 1.88 to 12.02; 2 trials, 82 participants). Only one of the longer-term trials reported on exacerbations, as measured by hospitalisations and courses of antibiotics. Only the second longer-term trial presented results for participant-reported outcomes. Three trials narratively reported adverse events, and these were all mild. Three single-dose trials and the two longer trials reported on forced vital capacity (FVC), and five trials reported on peak expiratory flow, i.e. forced expiratory flow between 25% and 75% (FEF25-75). One trial reported on airway clearance in terms of sputum weight. We judged the certainty of evidence for each of these outcomes to be very low, meaning we are very uncertain about the effect of short-acting inhaled beta-2 agonists on any of the outcomes we assessed. Short-acting inhaled muscarinic antagonists versus placebo All four trials reporting on this comparison looked at the effects of ipratropium bromide, but in different doses and via different delivery methods. One trial reported FEV1 % predicted; three trials measured this in L. Two trials reported adverse events, but these were few and mild. One trial reported FVC and three trials reported FEF25-75. None of the trials reported on quality of life, exacerbations or airway clearance. We judged the certainty of evidence for each of these outcomes to be very low, meaning we are very uncertain about the effect of short-acting inhaled muscarinic antagonists on any of the outcomes we assessed. Short-acting inhaled beta-2 agonists versus short-acting inhaled muscarinic antagonists None of the three single-dose trials reporting on this comparison provided data we could analyse. The original papers from three trials report that both treatments lead to an improvement in FEV1 L. Only one trial reported on adverse events; but none were experienced by any participant. No trial reported on any of our other outcomes. We judged the certainty of evidence to be very low, meaning we are very uncertain about the effect of short-acting inhaled beta-2 agonists compared to short-acting inhaled muscarinic antagonists on any of the outcomes we assessed. AUTHORS' CONCLUSIONS All included trials in this review are small and of a cross-over design. Most trials looked at very short-term effects of inhaled bronchodilators, and therefore did not measure longer-term outcomes. The certainty of evidence across all outcomes was very low, and therefore we have been unable to describe any effects with certainty.
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Affiliation(s)
- Sherie Smith
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nicola J Rowbotham
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christopher T Edwards
- Leeds Regional Paediatric Respiratory & Cystic Fibrosis Centre, A Floor, Clarendon Wing, Leeds Children's Hospital, Leeds, UK
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Perrem L, Stanojevic S, Shaw M, Pornillos M, Guido J, Sanders DB, Solomon M, Grasemann H, Sweezey N, Waters V, Davis SD, Ratjen F. Comparative analysis of respiratory symptom scores to detect acute respiratory events in children with cystic fibrosis. J Cyst Fibros 2022; 22:296-305. [PMID: 35753986 DOI: 10.1016/j.jcf.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are important outcome measures in research and clinical practice. This study describes the longitudinal variability the Cystic Fibrosis Questionnaire-Revised (CFQ-R) Respiratory score and the Chronic Respiratory Infection Symptom Score (CRISS), as well as their ability to identify acute respiratory events in children with CF. METHODS In this prospective observational study, the parent-proxy (6 -13 years) and self-reported (6-18 years) CFQ-R Respiratory score and CRISS (6-18 years) were measured every 3 months over 2 years. The lung clearance index (LCI) and FEV1 were also measured. We compared the diagnostic accuracy of the PROs in distinguishing acute respiratory events and clinically stable visits, using the minimal important difference of each PRO as the threshold. RESULTS A total of 98 children with CF were included. On average, the symptom scores did not change between clinically stable visits. The positive predictive value (PPV) and negative predictive value (NPV) of a ≥8.5-point worsening in the parent-proxy CFQ-R score to identify acute respiratory events (n=119) (PPV 70.2% and NPV 87.0%) were higher than for the self-reported CFQ-R score (PPV 58.9% and NPV 72.2%). The PPV and NPV of an ≥11-point change in the CRISS for acute respiratory events (n=137) was 56.5% and 79.6%, respectively. The PPV and NPV of all PROs were increased when combined with the LCI and/or FEV1pp. CONCLUSION Symptoms scores differ in their ability to identify acute respiratory events in children with CF; PPV and NPV of all PROs were improved when combined with lung function outcomes.
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Affiliation(s)
- Lucy Perrem
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada; Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Children's Health Ireland, Dublin 5, Ireland.
| | - Sanja Stanojevic
- Institute of Health Policy Management and Evaluation, University of Toronto, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Michelle Shaw
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Maryjess Pornillos
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Julia Guido
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Don B Sanders
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Melinda Solomon
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada
| | - Hartmut Grasemann
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Neil Sweezey
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Valerie Waters
- Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Stephanie D Davis
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Felix Ratjen
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada
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Newman C, Kgosidialwa O, Dervan L, Bogdanet D, Egan AM, Biesty L, Devane D, O'Shea PM, Dunne FP. Quality of patient-reported outcome reporting in trials of diabetes in pregnancy: A systematic review. Diabetes Res Clin Pract 2022; 188:109879. [PMID: 35483543 DOI: 10.1016/j.diabres.2022.109879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
AIMS Patient-reported outcomes (PROs) are reports of the patient's health status that come directly from the patient without interpretation by the clinician or anyone else. They are increasingly used in randomised controlled trials (RCTs). In this systematic review we identified RCTs conducted in women with diabetes in pregnancy which included PROs in their primary or secondary outcomes. We then evaluated the quality of PRO reporting against an internationally accepted reporting framework (Consolidated Standards of Reporting Trials (CONSORT-PRO) guidelines). METHODS We searched online databases for studies published 2013-2021 using a combination of keywords. Two authors reviewed all abstracts independently. Data on study characteristics and the quality of PRO reporting were extracted from relevant studies. We conducted a multiple regression analysis to identify factors associated with high quality reporting. RESULTS We identified 7122 citations. Thirty-five articles were included for review. Only 17% of RCTs included a PRO as a primary or secondary outcome. Out of a maximum score of 100 the median score was 46, indicating sub-optimal reporting. A multiple regression analysis did not reveal any factors associated with high quality reporting. CONCLUSIONS Researchers should be mindful of the importance of PRO inclusion and reporting and include reliable PROs in trials.
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Affiliation(s)
- C Newman
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.
| | - O Kgosidialwa
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - L Dervan
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D Bogdanet
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - A M Egan
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - L Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - D Devane
- HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland; INFANT Centre and Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - P M O'Shea
- Department of Clinical Biochemistry, Galway University Hospital, Galway, Ireland
| | - F P Dunne
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
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Lee DJ, Sykes J, Griffin K, Noel CW, Hyung B, Chokar K, Yao CM, Tullis E, Lee JM. The negative impact of chronic rhinosinusitis on the health-related quality of life among adult patients with cystic fibrosis. J Cyst Fibros 2022; 21:800-806. [PMID: 35660273 DOI: 10.1016/j.jcf.2022.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/06/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND With improved survival in cystic fibrosis (CF) patients, it is crucial to evaluate the impact of chronic co-morbidities such as chronic rhinosinusitis (CRS). The objectives were 1) To determine the prevalence of CRS with a large series of CF patients 2) To evaluate the impact of CRS on the Health-Related Quality of Life (HRQoL) of CF patients and 3) To compare CRS-specific, CF-specific and general HRQoL instruments. METHODS Consecutive CF patients from the Toronto Adult Cystic Fibrosis Centre were recruited between March 2018 and January 2020. Participants completed the 22-Item Nasal Outcome Test (SNOT-22), Cystic Fibrosis Questionnaire-Revised for adolescents and adults over 14 years of age (CFQ-R), Cystic Fibrosis Quality of Life Evaluative Self-administered Test (CF-QUEST) and the 36-Item Short Form Survey (SF-36). HRQoL scores were correlated using Spearman's correlation coefficients. RESULTS Out of 195 patients eligible for analysis, the prevalence of CRS with positive endoscopic findings was 42.6% (95% confidence interval: 35.5-49.8%). CRS patients reported significantly lower HRQoL with higher SNOT-22 scores and lower scores in the respiratory domain of CFQ-R and physical health domains of CF-QUEST and SF-36. The physical (ρ= -0.63) and mental (ρ= -0.66) domains of SF-36 and CF-QUEST (ρ= -0.76) had a strong correlation with SNOT-22. Higher scores of SNOT-22 nasal subdomains correlated with lower scores of SF-36, CFQ-R and CF-QUEST. CONCLUSION CRS is a prevalent co-morbidity of CF patients, which significantly reduces HRQoL. SNOT-22, CFQ-R, CF-QUEST and SF-36 were strongly correlated. Severity of sinonasal symptoms have a strong correlation with HRQoL in CF patients.
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Sykes
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Katherine Griffin
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Hyung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kamalprit Chokar
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Christopher Mkl Yao
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Tullis
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John M Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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10
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Efficacy and safety of elexacaftor plus tezacaftor plus ivacaftor versus tezacaftor plus ivacaftor in people with cystic fibrosis homozygous for F508del-CFTR: a 24-week, multicentre, randomised, double-blind, active-controlled, phase 3b trial. THE LANCET RESPIRATORY MEDICINE 2022; 10:267-277. [DOI: 10.1016/s2213-2600(21)00454-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022]
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11
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Pattie P, Ranganathan S, Harrison J, Vidmar S, Hall GL, Foong RE, Harper A, Ramsey K, Wurzel D. Quality of life is poorly correlated to lung disease severity in school-aged children with cystic fibrosis. J Cyst Fibros 2021; 21:e188-e203. [PMID: 34801433 DOI: 10.1016/j.jcf.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no data exclusively on the relationship between health-related quality-of-life (HRQOL) and lung disease severity in early school-aged children with cystic fibrosis (CF). Using data from the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) we assessed the relationships between HRQOL, lung function and structure. METHODS 125 children aged 6.5-10 years enrolled in the AREST CF program were included from CF clinics at Royal Children's Hospital (RCH), Melbourne (n = 66) and Perth Children's Hospital (PCH), Perth (n = 59), Australia. Demographics, HRQOL measured by Cystic Fibrosis Questionnaire-Revised (CFQ-R), spirometry, multiple-breath washout (MBW) and chest CT were collected across two years. Correlation between CFQ-R scores and lung structure/function parameters and agreement between parent-proxy and child-reported HRQOL were evaluated. RESULTS No correlation was observed between most CFQ-R domain scores and FEV1 z-scores, excepting weak-positive correlation with parent CFQ-R Physical (rho = 0.21, CI 0.02-0.37), and Weight (rho = 0.21, CI 0.03-0.38) domain and child Body domain (rho = 0.26, CI 0.00-0.48). No correlation between most CFQ-R domain scores and LCI values was noted excepting weak-negative correlation with parent Respiratory (rho = -0.23, CI -0.41--0.05), Emotional (rho = -0.24, CI -0.43--0.04), and Physical (-0.21, CI -0.39--0.02) domains. Furthermore, structural lung disease on CT data demonstrated little to no association with CFQ-R parent and child domain scores. Additionally, no agreement between child self-report and parent-proxy CFQ-R scores was observed across the majority of domains and visits. CONCLUSION HRQOL correlated poorly with lung function and structure in early school-aged children with CF, hence clinical trials should consider these outcomes independently when determining study end-points.
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Affiliation(s)
- Phillip Pattie
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia.
| | - Sarath Ranganathan
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Joanne Harrison
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Suzanna Vidmar
- Department of Paediatrics, The University of Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Graham L Hall
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Rachel E Foong
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia; School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Alana Harper
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Kathryn Ramsey
- Wal-yan Respiratory Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia; Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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12
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Bernstein R, Lynn C, Faro A, Barker D, Quittner A. Pretransplant Quality of Life and Post-Transplant Survival in Adolescents with Cystic Fibrosis. J Pediatr Psychol 2021; 47:350-359. [PMID: 34718670 DOI: 10.1093/jpepsy/jsab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Cystic fibrosis (CF) is the most common indication for pediatric lung transplantation and the third most common for adults. The selection of candidates and timing of transplant is challenging and whether there is a survival benefit of this procedure for pediatric patients is controversial. Use of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a well-validated, disease-specific quality of life measure may improve pretransplant referral decision-making. METHODS This multicenter study evaluated whether specific domains on the CFQ-R (i.e., Physical Functioning, Respiratory Symptoms), assessed pretransplant, predicted survival 4-year post-transplant (n = 25). A two-step Cox regression, with physical predictors entered in step one (i.e., age, CF-related Diabetes, FEV1% predicted) and the Physical Functioning and Respiratory Symptoms CFQ-R scales entered in step two, was used to assess whether the CFQ-R explained additional and unique variance. Receiver Operating Characteristic (ROC) curves were used to assess the sensitivity and specificity of optimal cut-points of significant CFQ-R domains. RESULTS The Respiratory Symptoms scale predicted survival 4-year post-transplant (Exp(B) = 0.38, 95% CI = 0.14-1.01; area under the curve = 0.87) and once it was added to the model, no other individual predictors were significant. The incremental improvement beyond the physical parameters approached but did not reach statistical significance (χ2 Δ = 5.79, p = .06). CONCLUSIONS This study suggested that including patient-reported outcomes could aid pretransplant referral decision-making. The Respiratory Symptoms scale in particular may serve as a useful tool to help determine when to refer and evaluate an individual for transplant.
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Affiliation(s)
- Ruth Bernstein
- Wake Forest Baptist Medical Center, Bariatric and Weight Management, USA.,Department of Psychology, University of Miami, USA
| | - Courtney Lynn
- University of Colorado, School of Medicine, Department of Psychiatry, USA
| | | | - David Barker
- Division of Psychiatry and Human Behavior, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, USA
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13
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Leong S, Sharma RK, Safi C, DiMango E, Keating C, Gudis DA, Overdevest JB. Association of Quality of Life Measures and Otolaryngologic Care in Cystic Fibrosis Patients. Ann Otol Rhinol Laryngol 2021; 131:817-823. [PMID: 34514873 DOI: 10.1177/00034894211045636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Appropriate management of chronic rhinosinusitis (CRS) among patients with cystic fibrosis (CF) is important in improving quality of life. Otolaryngologists play a critical role in reducing CRS symptom burden. This study seeks to evaluate the role of patient-reported quality-of-life measures in guiding interventions for CF-related sinus disease. METHODS We performed a prospective, cross-sectional study of 105 patients presenting to a CF-accredited clinic between July and September 2018. Demographic data and sinus surgery history were collected, in addition to Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Disorders (QOD-NS) scores. Statistical analysis was conducted using correlation and non-parametric Mann-Whitney U tests. RESULTS Baseline well-care visits accounted for 71.4% of all clinical evaluations. Prior otolaryngology intervention was noted in 69 (66%) patients, where the majority of these patients (63/69; 91%) underwent endoscopic sinus surgery (ESS). Patients with a history of otolaryngology intervention had an average SNOT-22 score of 33.2 (SD = 20.6) compared to 24.9 (SD = 18.5) for patients without prior intervention (P = .048). The average QOD-NS score was 5.5 (SD = 6.4) among patients referred to otolaryngologists and 3.1 (SD = 5.7) for non-referred patients (P = .012). SNOT-22 and QOD-NS scores were modestly correlated (R of .43). CONCLUSION CF patients with symptoms resulting in worse quality-of-life assessments were more likely to have established coordinated care with an otolaryngologist. Further validation of the utility of SNOT-22 and QOD-NS questionnaires as care coordination metrics is necessary in the CF population.
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Affiliation(s)
- Stephen Leong
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Rahul K Sharma
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Chetan Safi
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Emily DiMango
- Department of Pulmonary, Allergy and Critical Care Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Claire Keating
- Department of Pulmonary, Allergy and Critical Care Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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14
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Gomes A, Patusco R, Chung M, Dreker MR, Byham-Gray L, Lapin C, Ziegler J. The associations between pediatric weight status and cystic fibrosis-related diabetes status and health-related quality of life among children and young adults with cystic fibrosis: A systematic review. Pediatr Pulmonol 2021; 56:2413-2425. [PMID: 34004081 DOI: 10.1002/ppul.25463] [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: 11/20/2020] [Revised: 04/23/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-shortening genetic disease, yet life expectancy has recently increased, shifting the focus to disease management and health-related quality of life (HRQoL). Identification of clinical factors, such as weight status and CF-related diabetes (CFRD), that are associated with HRQoL can inform clinicians about the patient's health perception. The goal of this systematic review was two prong: identify the association of pediatric weight status and HRQoL and determine how CFRD status impacts HRQoL. METHODS A systematic review of published research was conducted following the methodology in the Cochrane Handbook on Systematic Reviews for Interventional Studies. Results were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. Risk of bias was assessed using the National Heart Lung & Blood Institute tool. A meta-analysis was not performed due to variability of the inclusion/exclusion criteria, differences in outcome reporting, and insufficient primary outcome data to pool. RESULTS Nine studies met inclusion criteria (n = 6 explored weight status and n = 3 studied CFRD), for a total of 1585 subjects (CFRD cases = 87). Pediatric weight status was positively associated with HRQoL, most commonly the Body Image and Eating Disturbance domains. CFRD was negatively associated with HRQoL, specifically the Treatment Burden and Weight domains. CONCLUSIONS Based on the limited data available, improved pediatric weight status appears to increase HRQoL while a CFRD diagnosis appears to decrease HRQoL. More research is needed to fully understand the role of these clinical factors on HRQoL, especially with life expectancy increasing among those with CF.
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Affiliation(s)
- Allison Gomes
- Department of Nutrition, Cedar Crest College, Allentown, Pennsylvania, USA
| | - Rachael Patusco
- Medical Affairs-Wellness, GlaxoSmithKline Consumer Healthcare, USA
| | - Mei Chung
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Medford, Massachusetts, USA
| | - Margaret R Dreker
- Interprofessional Health Sciences Library, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Patient-Centered Outcomes Research in Nutrition-PCORN Lab, Rutgers University, Newark, New Jersey, USA
| | - Craig Lapin
- Pulmonary Division, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Jane Ziegler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions at Rutgers University, Newark, New Jersey, USA
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15
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Coucke R, Chansard A, Bontemps V, Grenet D, Hubert D, Martin C, Lammertyn E, Bardin E, Bulteel V, Chedevergne F, Bourgeois ML, Burgel PR, Honore I, de Keyser H, Kirszenbaum M, de Carli P, Sermet-Gaudelus I, Hayes K. "Il faut continuer à poser des questions" patient reported outcome measures in cystic fibrosis: An anthropological perspective. J Cyst Fibros 2021; 20:e108-e113. [PMID: 33648900 DOI: 10.1016/j.jcf.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND People with cystic fibrosis (pwCF) are central in the development of patient-led assessment tools. Qualitative analysis of a frequently used CF-specific patient-reported outcome measure (PROM) sought patient recommendations for development of a new quality of life (QoL) tool. METHODS We performed an inventory of PROMs, symptom-report and QoL tools used in clinical trials within the European Cystic Fibrosis Society Clinical Trial Network (ECFS-CTN) and in routine clinical practice among Cystic Fibrosis Europe and ECFS members. A qualitative study using cognitive interviews with pwCF and their caregivers reviewed the Cystic Fibrosis Questionnaire (CFQ), the French initial form of the Cystic Fibrosis Questionnaire-Revised (CFQ-R). RESULTS Survey results from 33 countries revealed over 70 tools used in routine clinical practice, utilized by clinical specialists (n=124), pwCF/parents/carers (n=49) and other allied health professionals (n=60). The CFQ-R was the main PROM used in clinical trials. The qualitative study enrolled 99 pwCF, 6 to 11 years (n=31); 12 to 18 years (n=38); >18 years (n=30) and 26 parents. Inductive thematic analysis based on the CFQ, revealed 19 key themes. Themes common across all cohorts included burden of treatment, impact of disease on day-to-day life, relationships/family, stress/mood, and nutrition. Themes unique to individual groups included, treatment when not symptomatic for the paediatric group; education/studies and planning for the future for adolescents, impact of anxiety and depression on day-to-day life for adults, and for parents, questions addressing anxiety and their role as carers. CONCLUSIONS Patient-centeredness is paramount in development of an up-to-date PROM in the era of novel therapies.
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Affiliation(s)
- Rosa Coucke
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | | | - Véronique Bontemps
- Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux, Campus Condorcet, Bâtiment Recherche Sud, 5 cours de Humanitiés, 93322 Aubervillers cedex, France
| | | | - Dominique Hubert
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Clémence Martin
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | | | | | | | - Frédérique Chedevergne
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Muriel Le Bourgeois
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Pierre-Régis Burgel
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Isabelle Honore
- Hôpital Cochin, Assistance Publique Hôpitaux de Paris and Université de Paris, Institut Cochin, Inserm U1016, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | | | - Maya Kirszenbaum
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Paola de Carli
- Association Vaincre la Mucoviscidose, 181 rue de Tolbiac, 75013 Paris, France
| | - Isabelle Sermet-Gaudelus
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressourcés et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades 149 rue de Sévres, INSERM U1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris 75743, France
| | - Kate Hayes
- European Cystic Fibrosis Society, Karup, Denmark; Northern Ireland Clinical Research Facility, The Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Ireland.
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Pulmonary Exacerbations in Adults With Cystic Fibrosis: A Grown-up Issue in a Changing Cystic Fibrosis Landscape. Chest 2021; 159:93-102. [PMID: 32966813 PMCID: PMC7502225 DOI: 10.1016/j.chest.2020.09.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Pulmonary exacerbations (PExs) are significant life events in people with cystic fibrosis (CF), associated with declining lung function, reduced quality of life, hospitalizations, and decreased survival. The adult CF population is increasing worldwide, with many patients surviving prolonged periods with severe multimorbid disease. In many countries, the number of adults with CF exceeds the number of children, and PExs are particularly burdensome for adults as they tend to require longer courses and more IV treatment than children. The approach to managing PExs is multifactorial and needs to evolve to reflect this changing adult population. This review discusses PEx definitions, precipitants, treatments, and the wider implications to health-care resources. It reviews current management strategies, their relevance in particular to adults with CF, and highlights some of the gaps in our knowledge. A number of studies are underway to try to answer some of the unmet needs, such as the optimal length of treatment and the use of nonantimicrobial agents alongside antibiotics. An overview of these issues is provided, concluding that with the changing landscape of adult CF care, the definitions and management of PExs may need to evolve to enable continued improvements in outcomes across the age spectrum of CF.
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Devereux G, Wrolstad D, Bourke SJ, Daines CL, Doe S, Dougherty R, Franco R, Innes A, Kopp BT, Lascano J, Layish D, MacGregor G, Murray L, Peckham D, Lucidi V, Lovie E, Robertson J, Fraser-Pitt DJ, O'Neil DA. Oral cysteamine as an adjunct treatment in cystic fibrosis pulmonary exacerbations: An exploratory randomized clinical trial. PLoS One 2020; 15:e0242945. [PMID: 33370348 PMCID: PMC7769283 DOI: 10.1371/journal.pone.0242945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emerging data suggests a possible role for cysteamine as an adjunct treatment for pulmonary exacerbations of cystic fibrosis (CF) that continue to be a major clinical challenge. There are no studies investigating the use of cysteamine in pulmonary exacerbations of CF. This exploratory randomized clinical trial was conducted to answer the question: In future pivotal trials of cysteamine as an adjunct treatment in pulmonary exacerbations of CF, which candidate cysteamine dosing regimens should be tested and which are the most appropriate, clinically meaningful outcome measures to employ as endpoints? METHODS AND FINDINGS Multicentre double-blind randomized clinical trial. Adults experiencing a pulmonary exacerbation of CF being treated with standard care that included aminoglycoside therapy were randomized equally to a concomitant 14-day course of placebo, or one of 5 dosing regimens of cysteamine. Outcomes were recorded on days 0, 7, 14 and 21 and included sputum bacterial load and the patient reported outcome measures (PROMs): Chronic Respiratory Infection Symptom Score (CRISS), the Cystic Fibrosis Questionnaire-Revised (CFQ-R); FEV1, blood leukocyte count, and inflammatory markers. Eighty nine participants in fifteen US and EU centres were randomized, 78 completed the 14-day treatment period. Cysteamine had no significant effect on sputum bacterial load, however technical difficulties limited interpretation. The most consistent findings were for cysteamine 450mg twice daily that had effects additional to that observed with placebo, with improved symptoms, CRISS additional 9.85 points (95% CI 0.02, 19.7) p = 0.05, reduced blood leukocyte count by 2.46x109 /l (95% CI 0.11, 4.80), p = 0.041 and reduced CRP by geometric mean 2.57 nmol/l (95% CI 0.15, 0.99), p = 0.049. CONCLUSION In this exploratory study cysteamine appeared to be safe and well-tolerated. Future pivotal trials investigating the utility of cysteamine in pulmonary exacerbations of CF need to include the cysteamine 450mg doses and CRISS and blood leukocyte count as outcome measures. CLINICAL TRIAL REGISTRATION NCT03000348; www.clinicaltrials.gov.
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Affiliation(s)
- Graham Devereux
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Danielle Wrolstad
- Precision for Medicine, Oncology and Rare Disease, Carlsbad, CA, United States of America
| | | | - Cori L. Daines
- Banner University of Arizona Medical Center, Tucson, Arizona, United States of America
| | - Simon Doe
- Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Ryan Dougherty
- San Francisco Critical Care Medical Group California Pacific Medical Center, San Francisco, United States of America
| | - Rose Franco
- The Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin, United States of America
| | | | - Benjamin T. Kopp
- Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Jorge Lascano
- University of Florida, Gainesville, Florida, United States of America
| | - Daniel Layish
- Central Florida Pulmonary Group, Orlando, Florida, United States of America
| | | | | | | | - Vincenzina Lucidi
- Ospedale Padiatrico Bambino Gesu Centro Fibrosi Cistica, Rome, Italy
| | - Emma Lovie
- NovaBiotics Ltd, Aberdeen, United Kingdom
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18
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Smith S, Calthorpe R, Herbert S, Smyth AR. Digital technology for monitoring adherence to inhaled therapies in people with cystic fibrosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine; University of Nottingham; Nottingham UK
| | | | - Sophie Herbert
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine; The University of Nottingham; Nottingham UK
| | - Alan R Smyth
- Division of Child Health, Obstetrics & Gynaecology (COG); School of Medicine, University of Nottingham; Nottingham UK
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Eber E, Trawinska-Bartnicka M, Sands D, Bellon G, Mellies U, Bolbás K, Quattrucci S, Mazurek H, Widmann R, Schoergenhofer C, Jilma B, Ratjen F. Aerosolized lancovutide in adolescents (≥12 years) and adults with cystic fibrosis - a randomized trial. J Cyst Fibros 2020; 20:61-67. [PMID: 32888826 DOI: 10.1016/j.jcf.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lancovutide activates a chloride channel (TMEM-16A) other than the cystic fibrosis (CF) transmembrane conductance regulator protein and could benefit CF patients. METHODS In this randomized, multi-center, double-blind, placebo-controlled, parallel-group trial 161 patients ≥12 years with a confirmed diagnosis of CF were randomized to either placebo (saline) or active drug in 3 different dosing schemes of 2.5mg inhaled lancovutide (once daily, every other day or twice a week) for eight weeks. The primary endpoint was the change in the forced expiratory volume in 1 second (FEV1) percent predicted. Secondary endpoints included further lung function parameters (FEV1 (absolute), functional vital capacity percent predicted, forced expiratory flow percent predicted, pulse oximetry), quality of life assessment, pulmonary exacerbations, hospitalization due to pulmonary exacerbations, time to first pulmonary exacerbation, duration of anti-inflammatory, mucolytic or antibiotic treatment, and safety. RESULTS There was no significant difference in the change in FEV1 percent predicted, quality of life, other lung function parameters, pulmonary exacerbations or requirement of additional treatment between groups. Overall, the inhalation of lancovutide was safe although a higher rate of adverse events, especially related to the respiratory system, occurred as compared to placebo. CONCLUSIONS Lancovutide did not improve FEV1 percent predicted when compared to placebo (NCT00671736).
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Affiliation(s)
- Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept. of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Maria Trawinska-Bartnicka
- Cystic Fibrosis Department, The Specialist Centre for Medical Care of Mother and Child, Gdansk, Poland
| | - Dorota Sands
- Cystic Fibrosis Centre, Institute of Mother and Child, Warsaw, Poland
| | - Gabriel Bellon
- Department of Pediatrics and Cystic Fibrosis Pediatric Center, University Claude Bernard, Lyon, France
| | - Uwe Mellies
- Children's Hospital, Department of Pediatric Pulmonology, Cystic Fibrosis Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katalin Bolbás
- Department of Pediatrics, Kaposi Mor Teaching Hospital, Mosdos, Hungary
| | - Serena Quattrucci
- Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Roma, Italy
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, National Tuberculosis and Lung Diseases Research Institute, Rabka, Poland
| | | | | | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, Translational Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Smith S, Rowbotham NJ, Edwards CT. Short-acting inhaled bronchodilators for cystic fibrosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine; University of Nottingham; Nottingham UK
| | - Nicola J Rowbotham
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine; The University of Nottingham; Nottingham UK
| | - Christopher T Edwards
- Leeds Regional Paediatric Respiratory & Cystic Fibrosis Centre; A Floor, Clarendon Wing, Leeds Children's Hospital; Leeds UK
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21
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Santana NN, Chaves CRMDM, Gonçalves CP, Gomes Junior SCDS. FACTORS ASSOCIATED TO QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS. ACTA ACUST UNITED AC 2020; 38:e2018397. [PMID: 32578674 PMCID: PMC7307721 DOI: 10.1590/1984-0462/2020/38/2018397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Abstract
Objective: To verify the association between quality of life, functional capacity and
clinical and nutritional status in children and adolescents with cystic
fibrosis (CF). Methods: Cross-sectional study, including patients from eight to 18 years old with
CF. Quality of life, functional capacity, nutritional status and clinical
status were evaluated with the Cystic Fibrosis Questionnaire; the 6-minute
walk test (6MWT) and manual gripping force (MGF); the height percentiles for
age and body mass index for age and respiratory function test, respectively.
Pearson and Spearman correlation tests and logistic regression were used to
analyze the data. Results: A total of 45 patients, 13.4±0.5 years old, 60% female, 60% colonized by
Pseudomonas aeruginosa and 57.8% with at least one
F508del mutation participated in the study. When assessing the perception of
quality of life, the weight domain reached the lowest values, and the
digestive domain, the highest. In the pulmonary function test, the forced
expiratory volume of the first second was 77.3±3.3% and the 6MWT and MGF
presented values within the normal range. There was an association between
quality of life and functional capacity, nutritional status and clinical
status of CF patients. Conclusions: The study participants had good clinical conditions and satisfactory values
of functional capacity and quality of life. The findings reinforce that the
assessment of quality of life may be important for clinical practice in the
management of treatment.
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Affiliation(s)
- Nelbe Nesi Santana
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, RJ, Brasil
| | | | - Christine Pereira Gonçalves
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, RJ, Brasil
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Cheney J, Vidmar S, Gailer N, Wainwright C, Douglas TA. Health-related quality-of-life in children with cystic fibrosis aged 5-years and associations with health outcomes. J Cyst Fibros 2020; 19:483-491. [DOI: 10.1016/j.jcf.2020.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/24/2022]
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Easy measurement of health related quality of life in patients with cystic fibrosis by the COPD assessment test (CAT) - A pilot study. Respir Med 2020; 168:105992. [PMID: 32469708 DOI: 10.1016/j.rmed.2020.105992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/07/2020] [Accepted: 04/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Quality of life (QOL) is an important patient-related outcome (PRO) in patients with cystic fibrosis (CF). There are several QOL questionnaires like the "Cystic Fibrosis Questionnaire Revised" (CFQ-R) or the "St George's Respiratory Questionnaire" (SGRQ) that are well validated in CF. The aim of the study was to evaluate whether the easily applicable "COPD assessment test" (CAT) can be used in CF patients. METHODS 42 CF patients were recruited within the PulmoHOM study, a prospective, observational cohort study. The CAT, the SGRQ and the CFQ-R were handed out to the patients. The spearman's rank correlation coefficient and the Cronbach's α coefficient were used for the statistical analysis. RESULTS The internal consistencies of the CAT, SGRQ and the CFQ-R were high (Cronbach's α coefficients = 0.89, 0.91 and 0.83). There were significant correlations between the CAT and the total score of the SGRQ (r = 0.851, p < 0.01), between the CAT and many items of the CFQ-R (physical score of the CFQ-R and total score of the CAT: r = -0.872, p < 0.01) and between the SGRQ and the CFQ-R (physical score of the CFQ-R and total score of the SGRQ: r = -0.878, p < 0.01). CONCLUSION The main finding was the high correlation between the CAT and the validated questionnaires in CF. The CAT is a PRO instrument that can be filled quickly and that correlates well with the CFQ-R. The CAT or similar tools might be applicable in the care of CF patients.
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Bradley JM, Anand R, O’Neill B, Ferguson K, Clarke M, Carroll M, Chalmers J, De Soyza A, Duckers J, Hill AT, Loebinger MR, Copeland F, Gardner E, Campbell C, Agus A, McGuire A, Boyle R, McKinney F, Dickson N, McAuley DF, Elborn S. A 2 × 2 factorial, randomised, open-label trial to determine the clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care over 52 weeks in adults with bronchiectasis: a protocol for the CLEAR clinical trial. Trials 2019; 20:747. [PMID: 31856887 PMCID: PMC6921594 DOI: 10.1186/s13063-019-3766-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current guidelines for the management of bronchiectasis (BE) highlight the lack of evidence to recommend mucoactive agents, such as hypertonic saline (HTS) and carbocisteine, to aid sputum removal as part of standard care. We hypothesise that mucoactive agents (HTS or carbocisteine, or a combination) are effective in reducing exacerbations over a 52-week period, compared to usual care. METHODS This is a 52-week, 2 × 2 factorial, randomized, open-label trial to determine the clinical effectiveness and cost effectiveness of HTS 6% and carbocisteine for airway clearance versus usual care - the Clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care (CLEAR) trial. Patients will be randomised to (1) standard care and twice-daily nebulised HTS (6%), (2) standard care and carbocisteine (750 mg three times per day until visit 3, reducing to 750 mg twice per day), (3) standard care and combination of twice-daily nebulised HTS and carbocisteine, or (4) standard care. The primary outcome is the mean number of exacerbations over 52 weeks. Key inclusion criteria are as follows: adults with a diagnosis of BE on computed tomography, BE as the primary respiratory diagnosis, and two or more pulmonary exacerbations in the last year requiring antibiotics and production of daily sputum. DISCUSSION This trial's pragmatic research design avoids the significant costs associated with double-blind trials whilst optimising rigour in other areas of trial delivery. The CLEAR trial will provide evidence as to whether HTS, carbocisteine or both are effective and cost effective for patients with BE. TRIAL REGISTRATION EudraCT number: 2017-000664-14 (first entered in the database on 20 October 2017). ISRCTN.com, ISRCTN89040295. Registered on 6 July/2018. Funder: National Institute for Health Research, Health Technology Assessment Programme (15/100/01). SPONSOR Belfast Health and Social Care Trust. Ethics Reference Number: 17/NE/0339. Protocol version: v3.0 Final_14052018.
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Affiliation(s)
- Judy Martina Bradley
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Rohan Anand
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Brenda O’Neill
- Centre for Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Kathryn Ferguson
- Northern Ireland Clinical Research Network, Belfast Health and Social Care Trust, Belfast, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Mary Carroll
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | - Anthony De Soyza
- NIHR Biomedical research centre (BRC) for Aging, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Jamie Duckers
- Cardiff and Vale University Health Board, University Hospital Llandough, Penarth, UK
| | - Adam T. Hill
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Michael R. Loebinger
- Faculty of Medicine, National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Fiona Copeland
- PCD Family Support Group, Ciliopathy Alliance, London, UK
| | - Evie Gardner
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Christina Campbell
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Roisin Boyle
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Fionnuala McKinney
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Naomi Dickson
- Northern Ireland Clinical Trials Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Danny F. McAuley
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Stuart Elborn
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Safi C, DiMango E, Keating C, Zhou Z, Gudis DA. Sinonasal quality-of-life declines in cystic fibrosis patients with pulmonary exacerbations. Int Forum Allergy Rhinol 2019; 10:194-198. [PMID: 31834674 DOI: 10.1002/alr.22485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND In cystic fibrosis (CF), the relationship between chronic rhinosinusitis (CRS) and pulmonary disease is poorly understood. The purpose of this study was to evaluate the relationship between scores on the 22-item Sino-Nasal Outcome Test (SNOT-22) and CF Questionnaire-revised for adolescents and adults over 14 (CFQ-R 14+), and pulmonary function tests in 2 cohorts of CF patients: those at their baseline health and those with a pulmonary exacerbation. METHODS Patients >18 years old seen in a Cystic Fibrosis Foundation-accredited clinic completed the SNOT-22 and CFQ-R 14+ instruments. Patients presenting for routine care represented the baseline cohort. Patients diagnosed with a pulmonary exacerbation represented the exacerbation cohort. Average SNOT-22 and CFQ-R 14+ scores for both groups were compared using a 2-sample t test, and correlation coefficient was calculated. RESULTS One hundred three patients were enrolled over 3 months (30 exacerbations and 73 baseline). Patients' mean age was 32 years (56% female and 44% male). Average SNOT-22 and CFQ-R 14+ scores were significantly worse for exacerbation patients (p = 0.001 and p = 0.0003, respectively). Percent predicted forced expiratory volume in 1 second and forced vital capacity were both higher for baseline patients (p = 0.002 and p = 0.001, respectively). Average SNOT-22 score for all patients was worse than the average score for non-CF, non-CRS patients. CONCLUSION CF patients with pulmonary exacerbations have worse SNOT-22 and CFQ-R 14+ scores than CF patients at their baseline health. This finding suggests a temporal relationship between sinonasal and pulmonary quality of life, and that worsening of both is associated with reduced pulmonary function.
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Affiliation(s)
- Chetan Safi
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
| | - Emily DiMango
- Department of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Claire Keating
- Department of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Zian Zhou
- Department of Statistics, Columbia University, New York, NY
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY
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Evaluation of Copeptin during Pulmonary Exacerbation in Cystic Fibrosis. Mediators Inflamm 2019; 2019:1939740. [PMID: 31736654 PMCID: PMC6816008 DOI: 10.1155/2019/1939740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/09/2019] [Accepted: 09/17/2019] [Indexed: 01/16/2023] Open
Abstract
Copeptin was found to be a stable biomarker of inflammation and stress response in cardiac, renal, metabolic, and respiratory conditions such as pneumonia. The aim of this study was to investigate the copeptin levels in biological fluids (serum and sputum supernatant) of cystic fibrosis pediatric patients during pulmonary exacerbation and remission and to investigate the possible influence of copeptin levels on disease severity and quality of life. Copeptin serum concentrations were measured in 28 pediatric cystic fibrosis (CF) patients: 13 in stable condition and 15 during pulmonary exacerbation. In 10 CF patients, copeptin was also measured in the sputum. In all the patients, we assessed complete blood count, BMI, sputum culture, lung function, and chest imaging (with Brasfield score). The severity of symptoms was assessed using the Shwachman-Kulczycki (SK) score, and the quality of life was assessed with the Cystic Fibrosis Quality of Life Questionnaire-Revised (CFQ-R). Copeptin concentrations in serum and sputum supernatant was measured using an ELISA kit. Statistical analysis was done in Statistica v.12. Serum and sputum copeptin levels were higher in CF patients during pulmonary exacerbation than in a stable period, but the differences were not significant (p = 0.58 and p = 0.13, respectively). Copeptin did not correlate significantly with any clinical, laboratory, or spirometry markers of exacerbation. There was, however, a significant inverse correlation between the serum copeptin level and symptoms severity (r = ‐0.77, p = 0.008) and radiological changes (r = ‐0.5626, p = 0.036) during pulmonary exacerbation in pediatric CF patients. Copeptin also inversely correlated with the quality of life domains in CF patients: vitality and eating habits, mostly loss of appetite (p = 0.031 and p = 0.016, respectively). Copeptin may be useful to identify patients with a higher risk of deterioration to improve their outcomes.
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Solé A, Olveira C, Pérez I, Hervás D, Valentine V, Baca Yepez AN, Olveira G, Quittner AL. Development and electronic validation of the revised Cystic Fibrosis Questionnaire (CFQ-R Teen/Adult). J Cyst Fibros 2018; 17:672-679. [DOI: 10.1016/j.jcf.2017.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/28/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
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Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis-Knowledge Gaps and Research Opportunities: Overview Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas 2018; 47:1180-1184. [PMID: 30325855 PMCID: PMC6201320 DOI: 10.1097/mpa.0000000000001176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A workshop was sponsored by the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, on July 25, 2018, in Pittsburgh, Penn. The workshop was designed to bring together a multidisciplinary group of experts to accelerate the development of therapeutics for clinical application in inflammatory diseases of the exocrine pancreas. Three separate working groups (acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis) were formed to address the needs, gaps, and opportunities. The working groups included patients with pancreatic diseases, pharmaceutical company leaders, basic scientists, clinical researchers, and representatives from the US Food and Drug Administration to assist with regulatory considerations and to identify the unmet needs, research targets, and opportunities to provide direction for successful development of therapeutic agents in these diseases. This article represents the summary of the overview presentations at the National Institute of Diabetes and Digestive and Kidney Diseases workshop including an ongoing drug trial in acute pancreatitis; a successful drug development network developed by the Cystic Fibrosis Foundation; and considerations for subject selection in drug trials, incorporating Food and Drug Administration guidelines on clinical trial design and clinical outcome measures. The summaries of each working group follow separately in accompanying articles.
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Powers JH, Howard K, Saretsky T, Clifford S, Hoffmann S, Llorens L, Talbot G. Patient-Reported Outcome Assessments as Endpoints in Studies in Infectious Diseases. Clin Infect Dis 2017; 63 Suppl 2:S52-6. [PMID: 27481954 DOI: 10.1093/cid/ciw317] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The goal of administering medical interventions is to help patients live longer or live better. In keeping with this goal, there has been increasing interest in taking the "voice" of the patient into account during the development process, specifically in the evaluation of treatment benefits of medical interventions, and use of patient-centered outcome data to justify reimbursement. Patient-reported outcomes (PROs) are outcome assessments (OAs) used to define endpoints that can provide direct evidence of treatment benefit on how patients feel or function. When PROs are appropriately developed, they can increase the efficiency and clinical relevance of clinical trials. Several PROs have been developed for OA in specific infectious diseases indications, and more are under development. PROs also hold promise for use in evaluating adherence, adverse effects, satisfaction with care, and routine clinical practice.
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Affiliation(s)
| | | | | | | | - Steve Hoffmann
- Foundation for the National Institutes of Health, Bethesda, Maryland
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Abstract
BACKGROUND Cystic fibrosis is a life-limiting inherited condition which affects one in 2500 newborns in the UK and 70,000 children and adults worldwide. The condition is multifaceted and affects many systems in the body. The respiratory system is particularly affected due to a build up of thickened secretions and a predisposition to infection. Inhaled bronchodilators are prescribed for 80% of people with cystic fibrosis in order to widen the airways and alleviate symptoms. Both short- and long-acting inhaled bronchodilators are used to improve respiratory symptoms. Short-acting inhaled bronchodilators take effect in minutes and typically last for four to eight hours (muscarinic antagonists). Long-acting inhaled bronchodilators also take effect within minutes but typically last for around 12 hours and sometimes longer. This review is one of two which are replacing a previously published review of both long- and short-acting inhaled bronchodilators. OBJECTIVES This review aims to evaluate long-acting inhaled bronchodilators in children and adults with cystic fibrosis in terms of clinical outcomes and safety. If possible, we aimed to assess the optimal drug and dosage regimen. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 10 October 2017.We also carried out a separate search of Embase and the reference lists of included trials. We searched clinical trials registries for any ongoing trials and made contact with pharmaceutical companies for any further trials.Date of Embase search: 11 October 2017. SELECTION CRITERIA Randomised or quasi-randomised parallel trials comparing long-acting inhaled bronchodilators (beta-2 agonists and muscarinic antagonists) with placebo, no treatment or a different long-acting inhaled bronchodilator in adults and children with cystic fibrosis. DATA COLLECTION AND ANALYSIS Both authors independently assessed trials for inclusion (based on title, abstract and full text). The authors independently assessed the included trials for quality and risk of bias and extracted data. Discrepancies were resolved by a third party. MAIN RESULTS The searches identified 195 unique references, of which 155 were excluded on title and abstract. We assessed the full texts of the remaining references, excluded 16 trials (28 references) and included four trials (12 references) in the review with 1082 participants.One trial (n = 16) measuring the effect of beta-2 agonists reported an improvement in forced expiratory volume at one second (FEV1) after treatment (at one month), but the trial was small with an unclear risk of bias so we judged the evidence to be very low quality. The trial did not report on participant-reported outcomes, quality of life or adverse events.Three trials (n = 1066) looked at the effects of the muscarinic antagonist tiotropium at doses of 2.5 µg and 5.0 µg in both the short term (up to 28 days) and the longer term (up to three months). Only one of the trials reported the change in FEV1 (L) after 28 days treatment and showed no significant difference between groups; with 2.5 µg tiotropium, mean difference (MD) -0.02 (95% confidence interval (CI) -0.13 to 0.09), or 5.0 µg tiotropium, MD 0.00 (95% CI -0.10 to 0.10) (moderate-quality evidence). All three trials of muscarinic antagonists provided data on adverse events which were found to differ little from placebo at doses of 2.5 µg, risk ratio (RR) 1.01 (95% CI 0.92 to 1.11) or 5.0 µg, RR 0.98 (95% CI 0.90 to 1.06). Very little participant-reported outcome data or quality of life data were available for analysis. Two of the trials were at low risk of bias overall whilst the remaining trial was at an unclear risk overall. AUTHORS' CONCLUSIONS Neither long-acting beta-2 agonists nor long-acting muscarinic antagonist bronchodilators demonstrate improvement in our primary outcome of FEV1. No difference was observed between intervention and placebo in terms of quality of life or adverse events. The quality of evidence for the use of beta-2 agonists was very low. The use of a long-acting inhaled bronchodilator may help to reduce the burden of treatment for people with cystic fibrosis as it is taken less often than a short-acting inhaled bronchodilator, but future trials would benefit from looking at the effects on our primary outcomes (spirometric changes from baseline, quality of life and adverse effects) in the longer term.
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Affiliation(s)
- Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, The University of Nottingham, 1701 E Floor, East Block Queens Medical Centre, Nottingham, NG7 2UH, UK
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Rowe S, Daines C, Ringshausen F, Kerem E, Wilson J, Tullis E, Nair N, Simard C, Han L, Ingenito E, McKee C, Lekstrom-Himes J, Davies J. Tezacaftor-Ivacaftor in Residual-Function Heterozygotes with Cystic Fibrosis. N Engl J Med 2017; 377:2024-2035. [PMID: 29099333 PMCID: PMC6472479 DOI: 10.1056/nejmoa1709847] [Citation(s) in RCA: 356] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cystic fibrosis is an autosomal recessive disease caused by mutations in the CFTR gene that lead to progressive respiratory decline. Some mutant CFTR proteins show residual function and respond to the CFTR potentiator ivacaftor in vitro, whereas ivacaftor alone does not restore activity to Phe508del mutant CFTR. METHODS We conducted a randomized, double-blind, placebo-controlled, phase 3, crossover trial to evaluate the efficacy and safety of ivacaftor alone or in combination with tezacaftor, a CFTR corrector, in 248 patients 12 years of age or older who had cystic fibrosis and were heterozygous for the Phe508del mutation and a CFTR mutation associated with residual CFTR function. Patients were randomly assigned to one of six sequences, each involving two 8-week intervention periods separated by an 8-week washout period. They received tezacaftor-ivacaftor, ivacaftor monotherapy, or placebo. The primary end point was the absolute change in the percentage of predicted forced expiratory volume in 1 second (FEV1) from the baseline value to the average of the week 4 and week 8 measurements in each intervention period. RESULTS The number of analyzed intervention periods was 162 for tezacaftor-ivacaftor, 157 for ivacaftor alone, and 162 for placebo. The least-squares mean difference versus placebo with respect to the absolute change in the percentage of predicted FEV1 was 6.8 percentage points for tezacaftor-ivacaftor and 4.7 percentage points for ivacaftor alone (P<0.001 for both comparisons). Scores on the respiratory domain of the Cystic Fibrosis Questionnaire-Revised, a quality-of-life measure, also significantly favored the active-treatment groups. The incidence of adverse events was similar across intervention groups; most events were mild or moderate in severity, with no discontinuations of the trial regimen due to adverse events for tezacaftor-ivacaftor and few for ivacaftor alone (1% of patients) and placebo (<1%). CONCLUSIONS CFTR modulator therapy with tezacaftor-ivacaftor or ivacaftor alone was efficacious in patients with cystic fibrosis who were heterozygous for the Phe508del deletion and a CFTR residual-function mutation. (Funded by Vertex Pharmaceuticals and others; EXPAND ClinicalTrials.gov number, NCT02392234 .).
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Affiliation(s)
- S.M. Rowe
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - C. Daines
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, United States
| | - F.C. Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, and German Center for Lung Research (DZL), Hannover, Germany
| | - E. Kerem
- Hadassah Hebrew University Medical Center, Israel
| | | | - E. Tullis
- St. Michael’s Hospital, Toronto, ON, Canada
| | - N. Nair
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - C. Simard
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - L. Han
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - E.P. Ingenito
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - C. McKee
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | | | - J.C. Davies
- Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
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Caregiver burden of parents of young children with cystic fibrosis. J Cyst Fibros 2017; 17:125-131. [PMID: 29150357 DOI: 10.1016/j.jcf.2017.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/20/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of research examining the impact of informal caregiving on parents of young children with cystic fibrosis (CF). The aim of this study was to examine caregiver burden and identify risk factors associated with high caregiver burden in mothers and fathers of young children with CF. METHODS This was a cross-sectional study of parents of young children with CF. A total of 213 families were invited to complete the CarerQoL questionnaire, a validated tool composed of two parts: (i) the CarerQol-7D which describes the care situation in terms of the negative and positive effects of caregiving and (ii) the visual analogue scale (VAS) which measures happiness on a scale from 0 to 10 (0=completely unhappy and 10=completely happy). The utility score (US) is a weighted average of the subjective burden derived from the CarerQol-7D (0-100); higher US indicates reduced burden. Differences in mother-father dyad median utility scores were examined using Wilcoxon signed rank test. Generalised linear mixed models were used to identify factors associated with high caregiver burden. RESULTS At least one parent from 195 families completed the questionnaire (130 mother-father dyads, 189 mothers and 137 fathers). Fathers had a significantly higher median utility score than mothers [(89.2 (IQR 79.6-96.5) vs. 84.7 (74.5-88.0) p<0.001]. Factors found to be significantly associated with higher caregiver burden were increasing child age (OR 1.02; CI: 1.00-1.04), having a child ever positive for Pseudomonas aeruginosa (Pa) (OR 2.48; CI: 1.30-4.73) and being a mother (OR 1.65; CI: 1.02-2.65). CONCLUSIONS This study contributes new findings to the sparse literature on caregiver burden of parents of young children with CF. Increasing child age and infection with Pa, associated with higher morbidity, were linked to greater parental burden.
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Primary Ciliary Dyskinesia: First Health-related Quality-of-Life Measures for Pediatric Patients. Ann Am Thorac Soc 2017; 13:1726-1735. [PMID: 27464304 DOI: 10.1513/annalsats.201603-198oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Primary ciliary dyskinesia (PCD) is a rare disease. There are no available data on disease-specific pediatric patient-reported outcomes. OBJECTIVES Our objective was to create developmentally appropriate, health-related quality-of-life questionnaires (QOL-PCD) for children (6-12 yr) and adolescents (13-17 yr) with PCD and a parent proxy measure. METHODS The QOL-PCD was developed using a cross-cultural protocol-driven approach satisfying both North American and European drug regulatory agency guidelines. A conceptual framework was generated by literature review, focus groups (expert clinicians and patients/parents), and open-ended interviews with children, adolescents, and parents of patients with PCD. We recruited participants from international research consortiums, PCD clinics, and patient advocacy groups, aiming for representation of a wide spectrum of disease severity, sociodemographic status, and ethnicity. Qualitative interviews were conducted by trained and experienced research assistants and psychologists. Transcripts were content-analyzed with Atlas.ti/NVivo to assess saturation of content. A self-completed item relevance survey was administered to E.U. PARTICIPANTS Qualitative and quantitative data were used to construct draft instruments. Questionnaires were further refined after cognitive interviews. MEASUREMENTS AND MAIN RESULTS Focus groups (n = 62 experts; n = 20 patients/parents) and open-ended interviews with patients/parents (n = 69; 34 males; age at diagnosis, 0-15 yr; FEV1, 58-118% predicted) revealed a wide spectrum of issues unique to this population. Content analysis of transcripts identified the following domains, depending on age: Respiratory Symptoms, Physical Functioning, Emotional Functioning, Treatment Burden, Ears and Hearing, Sinus Symptoms, Social Functioning, Role Functioning, Vitality, Health Perceptions, School Functioning, and Eating and Weight. Various items were retained in questionnaires, based on age and role of respondent: 37, 43, and 41 items for children, adolescents, and parent proxy, respectively. The item relevance survey (n = 57) yielded results similar to those of open-ended interviews. Cognitive testing (n = 47; 20 males; age at diagnosis, 0-11 yr; FEV1, 49-124% predicted) confirmed that items and response choices were clear and understood by respondents, and that all relevant items were included. CONCLUSIONS The QOL-PCD measures, developed using rigorous, protocol-driven methods and international collaborations, have demonstrated content validity and cross-cultural equivalence for implementation in English-speaking populations. Psychometric testing is underway to determine their measurement properties for evaluating clinical interventions and informing quality of care.
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Ronit A, Gelpi M, Argentiero J, Mathiesen I, Nielsen SD, Pressler T, Quittner AL. Electronic applications for the CFQ-R scoring. Respir Res 2017; 18:108. [PMID: 28558706 PMCID: PMC5450183 DOI: 10.1186/s12931-017-0592-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
Patient reported outcomes (PROs) have become widely accepted outcome measures in cystic fibrosis (CF) and other respiratory diseases. The Cystic Fibrosis-Questionnaire-Revised (CFQ-R) is the best validated and most widely used PRO for CF. Data collection can be time-intensive, and electronic platforms would greatly facilitate the feasibility, utility and accuracy of administration of the CFQ-R. Given that the CFQ-R is utilized in virtually all clinical trials worldwide and is increasingly integrated into clinical practice, we developed a software application that will help users to administer, score and save CFQ-R data for all versions. All codes are open access, which will enable other PRO users to design similar applications for other respiratory diseases, such as primary ciliary dyskinesia and non-CF bronchiectasis.
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Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases 8632, University Hospital of Copenhagen, Copenhagen, Denmark.
| | - Marco Gelpi
- Department of Infectious Diseases 8632, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jonathan Argentiero
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Inger Mathiesen
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases 8632, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Tanja Pressler
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, University Hospital of Copenhagen, Copenhagen, Denmark
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The psychometric properties of the Leicester Cough Questionnaire and Respiratory Symptoms in CF tool in cystic fibrosis: A preliminary study. J Cyst Fibros 2017; 16:425-432. [DOI: 10.1016/j.jcf.2016.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 01/11/2023]
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van Horck M, Winkens B, Wesseling G, de Winter-de Groot K, de Vreede I, Jöbsis Q, Dompeling E. Factors associated with changes in health-related quality of life in children with cystic fibrosis during 1-year follow-up. Eur J Pediatr 2017; 176:1047-1054. [PMID: 28597092 PMCID: PMC5511302 DOI: 10.1007/s00431-017-2928-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 01/20/2023]
Abstract
UNLABELLED There are limited data on health-related quality of life (HRQoL) changes over time in children with cystic fibrosis (CF). We investigated associations between clinical and treatment variables with changes in HRQoL during 1 year. Forty-nine children with CF aged 6-18 years were followed in this multicentre, observational cohort study during 1 year. HRQoL was measured by the validated disease specific cystic fibrosis questionnaire-revised (CFQ-R). The CFQ-R total score as well as most domain scores improved significantly (8.0 points and [3.3-31.7] points respectively) during the one-year follow-up. Age at baseline demonstrated a strong longitudinal association with the change of CFQ-R total score (2.853 points decrease of CFQ-R total score per year increase in age) and several domain scores. Below 12 years of age, CFQ-R total score improved in most children, whereas a deterioration was observed in most children above 12 years. The number of PEx was associated with an increase of treatment burden score (4.466 points decrease per extra PEx). CONCLUSION In the group as a whole, HRQoL improved significantly over time. However, changes over time were significantly influenced by age: below 12 years of age, HRQoL improved in most patients whereas a deterioration was observed in most children >12 years. Strategies how to preserve or ideally to improve HRQoL in adolescence should be developed. What is known: • Quality of life in patient with CF is diminished • Although CF is a chronic disease, longitudinal data on QoL in children with CF are scarce. What is new: • Below 12 years of age, quality of life improved in most children during the 1-year follow-up whereas a deterioration in quality of life was observed in most children above 12 years. • the treatment burden score of QoL correlated with the exacerbation rate.
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Affiliation(s)
- Marieke van Horck
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Health Care (CAPHRI), Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, MUMC+, Maastricht, The Netherlands
| | - Geertjan Wesseling
- Department of Respiratory Medicine, CAPHRI, MUMC+, Maastricht, The Netherlands
| | - Karin de Winter-de Groot
- Department of Paediatric Respiratory Medicine, Wilhelmina Children’s Hospital, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Ilja de Vreede
- Department of Paediatric Respiratory Medicine, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Quirijn Jöbsis
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Health Care (CAPHRI), Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
| | - Edward Dompeling
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Health Care (CAPHRI), Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
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Devereux G, Steele S, Griffiths K, Devlin E, Fraser-Pitt D, Cotton S, Norrie J, Chrystyn H, O'Neil D. An Open-Label Investigation of the Pharmacokinetics and Tolerability of Oral Cysteamine in Adults with Cystic Fibrosis. Clin Drug Investig 2016; 36:605-12. [PMID: 27153825 PMCID: PMC4951511 DOI: 10.1007/s40261-016-0405-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background and Objective Cysteamine is licensed for use in nephropathic cystinosis but preclinical data suggest a role in managing cystic fibrosis (CF). This study aimed to determine whether oral cysteamine is absorbed in adult CF patients and enters the bronchial secretions. Tolerability outcomes were also explored. Methods Patients ≥18 years of age, weighing >50 kg with stable CF lung disease were commenced on oral cysteamine bitartrate (Cystagon®) 450 mg once daily, increased weekly to 450 mg four times daily. Serial plasma cysteamine concentrations were measured for 24 h after the first dose. Participants were reviewed every week for 6 weeks, except at 4 weeks. Plasma cysteamine concentrations were measured 8 h after dosing when reviewed at 1, 2 and 3 weeks and 6 h after dosing when reviewed at 5 weeks. Sputum cysteamine concentration was also quantified at the 5-week assessment. Results Seven of the ten participants reported adverse reactions typical of cysteamine, two participants discontinued intervention. Following the first 450-mg dose, mean (SD) maximum concentration (Cmax) was 2.86 (1.96) mg/l, the time corresponding to Cmax (Tmax) was 1.2 (0.7) h, the half-life (t½) was 3.7 (1.7) h, clearance (CL/F) 89.9 (30.5) L/h and volume of distribution (Vd/F) 427 (129) L. Cysteamine appeared to accumulate in sputum with a median (interquartile range) sputum:plasma cysteamine concentration ratio of 4.2 (0.98–8.84). Conclusion Oral cysteamine is absorbed and enters the bronchial secretions in patients with CF. Although adverse reactions were common, the majority of patients continued with cysteamine. Further trials are required to establish the risk benefit ratio of cysteamine therapy in CF.
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Affiliation(s)
- Graham Devereux
- Cystic Fibrosis Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK. .,Child Health, Royal Aberdeen Children's Hospital, Aberdeen, AB25 2ZG, UK.
| | - Sandra Steele
- Cystic Fibrosis Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - Kairen Griffiths
- Cystic Fibrosis Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - Edward Devlin
- Cystic Fibrosis Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.,Novabiotics Ltd, Cruickshank Building, Craibstone, Aberdeen, UK
| | | | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - John Norrie
- Centre for Healthcare Randomised Trials, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK
| | - Henry Chrystyn
- Talmedica Ltd, St Crispin House, St Crispin Way, Haslingden, Rossendale, UK
| | - Deborah O'Neil
- Novabiotics Ltd, Cruickshank Building, Craibstone, Aberdeen, UK
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Kobbernagel HE, Buchvald FF, Haarman EG, Casaulta C, Collins SA, Hogg C, Kuehni CE, Lucas JS, Omran H, Quittner AL, Werner C, Nielsen KG. Study protocol, rationale and recruitment in a European multi-centre randomized controlled trial to determine the efficacy and safety of azithromycin maintenance therapy for 6 months in primary ciliary dyskinesia. BMC Pulm Med 2016; 16:104. [PMID: 27450411 PMCID: PMC4957315 DOI: 10.1186/s12890-016-0261-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/25/2016] [Indexed: 11/24/2022] Open
Abstract
Background Clinical management of primary ciliary dyskinesia (PCD) respiratory disease is currently based on improving mucociliary clearance and controlling respiratory infections, through the administration of antibiotics. Treatment practices in PCD are largely extrapolated from more common chronic respiratory disorders, particularly cystic fibrosis, but no randomized controlled trials (RCT) have ever evaluated efficacy and safety of any pharmacotherapeutics used in the treatment of PCD. Maintenance therapy, with the macrolide antibiotic azithromycin, is currently widely used in chronic respiratory diseases including PCD. In addition to its antibacterial properties, azithromycin is considered to have beneficial anti-inflammatory and anti-quorum-sensing properties. The aim of this study is to determine the efficacy of azithromycin maintenance therapy for 6 months on respiratory exacerbations in PCD. The secondary objectives are to evaluate the efficacy of azithromycin on lung function, ventilation inhomogeneity, hearing impairment, and symptoms (respiratory, sinus, ears and hearing) measured on a PCD-specific health-related quality of life instrument, and to assess the safety of azithromycin maintenance therapy in PCD. Methods The BESTCILIA trial is a European multi-centre, double-blind, randomized, placebo-controlled, parallel group study. The intervention is tablets of azithromycin 250/500 mg according to body weight or placebo administered three times a week for 6 months. Subjects with a confirmed diagnosis of PCD, age 7–50 years, are eligible for inclusion. Chronic pulmonary infections with Gram-negative bacteria or any recent occurrence of non-tuberculous mycobacteria are exclusion criteria. The planned number of subjects to be included is 125. The trial has been approved by the Research Ethics Committees of the participating institutions. Discussion We present a study protocol of an ongoing RCT, evaluating for the first time, the efficacy and safety of a pharmacotherapeutic treatment for patients with PCD. The RCT evaluates azithromycin maintenance therapy, a drug already commonly prescribed in other chronic respiratory disorders. Furthermore, the trial will utilize the Lung clearance index and new, PCD-specific quality of life instruments as outcome measures for PCD. Recruitment is hampered by frequent occurrence of Pseudomonas aeruginosa infection, exacerbations at enrolment, and the patients’ perception of disease severity and necessity of additional management and treatment during trial participation. Trial registration EudraCT 2013-004664-58 (date of registration: 2014-04-08).
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Affiliation(s)
- Helene E Kobbernagel
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik F Buchvald
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Eric G Haarman
- Department of Pediatric Pulmonology, VU University Medical Center, Amsterdam, Netherlands
| | - Carmen Casaulta
- Division of Respiratory Medicine, Department of Pediatrics, Inselspital and University of Bern, Bern, Switzerland
| | - Samuel A Collins
- PCD Centre, NIHR Respiratory Biomedical Research Unit and Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Claire Hogg
- Paediatric Respiratory Department, Royal Brompton Hospital, London, UK
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jane S Lucas
- PCD Centre, NIHR Respiratory Biomedical Research Unit and Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
| | - Heymut Omran
- Department of General Paediatrics, University Children's Hospital Muenster, Muenster, Germany
| | | | - Claudius Werner
- Department of General Paediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Kim G Nielsen
- Danish Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Patient-reported symptoms and functioning as indicators of mortality in advanced cystic fibrosis: A new tool for referral and selection for lung transplantation. J Heart Lung Transplant 2016; 35:789-94. [DOI: 10.1016/j.healun.2016.01.1233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/02/2016] [Accepted: 01/26/2016] [Indexed: 11/24/2022] Open
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Kilcoyne A, Lavelle LP, McCarthy CJ, McEvoy SH, Fleming H, Gallagher A, Loeve M, Tiddens H, McKone E, Gallagher CC, Dodd JD. Chest CT abnormalities and quality of life: relationship in adult cystic fibrosis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:87. [PMID: 27047946 DOI: 10.21037/atm.2016.03.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND To evaluate the relationship between lung parenchymal abnormalities on chest CT and health-related quality of life in adult cystic fibrosis (CF). METHODS The chest CT scans of 101 consecutive CF adults (mean age 27.8±7.9, 64 males) were prospectively scored by two blinded radiologists in consensus using a modified Bhalla score. Health-related quality of life was assessed using the revised Quittner Cystic Fibrosis Questionnaire (CFQ-R). Multiple regressions were performed with each of the CFQ-R domains and all clinical and imaging findings to assess independent correlations. RESULTS There were 18 inpatients and 83 outpatients. For the cohort of inpatients, CT abnormalities were significantly (P<0.005 for all) associated with Respiratory Symptoms (Air Trapping), and also with Social Functioning (Consolidation) and Role Functioning (Consolidation). For outpatients, CT abnormalities were significantly (P<0.005 for all) associated with Respiratory Symptoms (Consolidation) and also with Physical Functioning (Consolidation), Vitality (Consolidation, Severity of Bronchiectasis), Eating Problems (airway wall thickening), Treatment Burden (Total CT Score), Body Image (Severity of Bronchiectasis) and Role Functioning (Tree-in-bud nodules). Consolidation was the commonest independent CT predictor for both inpatients (predictor for 2 domains) and outpatients (predictor in 3 domains). Several chest CT abnormalities excluded traditional measures such as FEV1 and BMI from the majority of CFQ-R domains. CONCLUSIONS Chest CT abnormalities are significantly associated with quality of life measures in adult CF, independent of clinical or spirometric measurements.
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Affiliation(s)
- Aoife Kilcoyne
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Lisa P Lavelle
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Colin J McCarthy
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Sinead H McEvoy
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Hannah Fleming
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Annika Gallagher
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Martine Loeve
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Harm Tiddens
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Edward McKone
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Charles C Gallagher
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jonathan D Dodd
- 1 Department of Radiology, 2 National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Elm Park, Dublin, Ireland ; 3 Department of Pediatric Pulmonology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands ; 4 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
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Elborn JS, Flume PA, Cohen F, Loutit J, VanDevanter DR. Safety and efficacy of prolonged levofloxacin inhalation solution (APT-1026) treatment for cystic fibrosis and chronic Pseudomonas aeruginosa airway infection. J Cyst Fibros 2016; 15:634-40. [PMID: 26935334 DOI: 10.1016/j.jcf.2016.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/11/2016] [Accepted: 01/30/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Levofloxacin inhalation solution (LIS) is the first aerosolized fluoroquinolone licensed for treatment of patients with cystic fibrosis (CF) and chronic Pseudomonas aeruginosa lung infection. This study evaluated the safety and efficacy of extended LIS treatment. METHODS Patients completing a multinational, randomized study comparing LIS and tobramycin inhalation solution (TIS) were enrolled in an open-label extension in which all patients received three additional cycles of 28days of LIS 240mg twice daily followed by 28days off drug. Endpoints included mean relative change in percent predicted forced expiratory volume in 1s (FEV1), time to pulmonary exacerbation, and patient-reported quality of life. RESULTS Extended treatment with LIS in 88 patients was well tolerated with no new safety signals and evidence of positive effects on FEV1 and quality of life. CONCLUSION Patients receiving extended LIS treatment continued to show favorable efficacy with no additional safety concerns.
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Affiliation(s)
- J Stuart Elborn
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK.
| | - Patrick A Flume
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Fredric Cohen
- Future Therapies, LLC, Washington Crossing, PA, USA.
| | | | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Devereux G, Fraser-Pitt D, Robertson J, Devlin E, Mercer D, O'Neil D. Cysteamine as a Future Intervention in Cystic Fibrosis Against Current and Emerging Pathogens: A Patient-based ex vivo Study Confirming its Antimicrobial and Mucoactive Potential in Sputum. EBioMedicine 2015; 2:1507-12. [PMID: 26629546 PMCID: PMC4634621 DOI: 10.1016/j.ebiom.2015.08.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 12/03/2022] Open
Abstract
Background Cysteamine has recently been shown to have in vitro properties potentially therapeutically beneficial in cystic fibrosis (CF). In this study we investigated the antimicrobial and mucolytic activity of cysteamine against the complex biologic matrix of CF sputum. Methods Sputum samples were obtained from 23 CF adults. Sputum polymicrobial content after in vitro exposure to cysteamine and standard CF antibiotics was assessed after a single exposure and after 14 days low-dose exposure. The effect of cysteamine on sputum spinnbarkeit was assessed. Findings Cysteamine reduced sputum polymicrobial burden by 3 · 18 (95% CI 2 · 30–4 · 07, p < 0.001) log10 units after 24 h incubation. Combined cysteamine and tobramycin reduced polymicrobial burden by a further 3 · 75 (95% CI 2 · 63–5 · 07, p < 0 · 001) log10 units above that seen with tobramycin. Repeated low dosing with cysteamine reduced sputum polymicrobial load from day 10 onwards (p = 0.032). Cysteamine reduced CF sputum viscoelasticity, sputum spinnbarkeit cysteamine 11.1 mm/s (95% CI 3.95–18.2) vs DNAse 1.69 mm/s (95% CI 0.73–2.65), p = 0.016. Cysteamine was active against Mycobacterium abscessus as a monotherapy and also potentiated the effects of amikacin and azithromycin. Conclusion Further investigation is required into the therapeutic potential of cysteamine in CF to treat emerging as well as established microbial pathogens and as a mucolytic agent. Cysteamine may have a role in treating cystic fibrosis. Cysteamine was added to sputum samples from 23 patients with cystic fibrosis. Cysteamine reduced microbial load and increased the effectiveness of tobramycin. Cysteamine greatly reduced the viscoelasticity of sputum. Cysteamine had activity against the emerging pathogen Mycobacterium abscessus.
Cystic fibrosis (CF) is a genetic disease that damages the lungs because the thick sticky mucus produced in CF airways becomes infected. There is a need to develop new treatments for CF lung infections. In this study we have taken sputum samples from 23 people with CF and shown that an investigational drug cysteamine reduces the number of bacteria in the sputum and also makes an antibiotic work better. Cysteamine also reduced sputum stickiness. These results suggest that cysteamine may have a role treating CF lung infections and further research is required to fully assess this.
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Affiliation(s)
- Graham Devereux
- Respiratory Group, University of Aberdeen, Aberdeen AB25 2ZG, UK
- Corresponding author at: Child Health, Royal Aberdeen Children's Hospital, Aberdeen AB25 2ZG, UK.Child HealthRoyal Aberdeen Children's HospitalAB25 2ZGAberdeenUK
| | | | - Jennifer Robertson
- NovaBiotics Ltd, Cruickshank Building, Craibstone, Aberdeen AB21 9TR, UK
| | - Edward Devlin
- Respiratory Group, University of Aberdeen, Aberdeen AB25 2ZG, UK
- NovaBiotics Ltd, Cruickshank Building, Craibstone, Aberdeen AB21 9TR, UK
| | - Derry Mercer
- NovaBiotics Ltd, Cruickshank Building, Craibstone, Aberdeen AB21 9TR, UK
| | - Deborah O'Neil
- NovaBiotics Ltd, Cruickshank Building, Craibstone, Aberdeen AB21 9TR, UK
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Quittner A, Suthoff E, Rendas-Baum R, Bayliss MS, Sermet-Gaudelus I, Castiglione B, Vera-Llonch M. Effect of ivacaftor treatment in patients with cystic fibrosis and the G551D-CFTR mutation: patient-reported outcomes in the STRIVE randomized, controlled trial. Health Qual Life Outcomes 2015; 13:93. [PMID: 26135562 PMCID: PMC4702321 DOI: 10.1186/s12955-015-0293-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/23/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is an inherited, rare autosomal recessive disease that results in chronically debilitating morbidities and high premature mortality. We evaluated how ivacaftor treatment affected CF symptoms, functioning, and well-being, as measured by the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a widely-used patient-reported outcome (PRO) measure. METHODS STRIVE, a double-blind, placebo-controlled randomized trial, evaluated ivacaftor (150 mg) in CF patients aged 12+ with the G551D-CFTR mutation for 48 weeks. Treatment effect analysis used a mixed-effects repeated measures model. Treatment benefit analyses applied the cumulative distribution function and a categorical analysis of change scores ("improvement," "no change," or "decline"). Content-based interpretation examined treatment effect on specific item responses. RESULTS Data from 152 patients with a baseline CFQ-R assessment were analyzed. The treatment effect analysis favored treatment with ivacaftor over placebo on the Body Image, Eating, Health Perceptions, Physical Functioning, Respiratory, Social Functioning, Treatment Burden, and Vitality scales. Findings were supported by the analysis of categorical change. On all CFQ-R scales, the percentage of patients who improved was greater for ivacaftor. In the content-based analysis, the treatment benefit was characterized by better scores across a broad range of domains. CONCLUSIONS Results illustrate broad benefits of ivacaftor treatment across many domains: respiratory symptoms, physical and social functioning, health perceptions, and vitality, as measured by the CFQ-R. The breadth of improvements reflects the systemic mechanism of action of ivacaftor compared to other therapies. Findings support the patient-reported value of ivacaftor treatment in this patient population. TRIAL REGISTRATION ClinicalTrials.gov NCT00909532.
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Affiliation(s)
- Alexandra Quittner
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA.
| | - Ellison Suthoff
- Vertex Pharmaceuticals Incorporated, 50 Northern Avenue, Boston, MA, 02210, USA.
| | | | | | - Isabelle Sermet-Gaudelus
- Hopital Necker Enfants Malades, Universite Paris Sorbonne, 149 Rue de Sèvres, Paris, 75015, France.
| | - Brenda Castiglione
- Vertex Pharmaceuticals Incorporated, 50 Northern Avenue, Boston, MA, 02210, USA.
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Abstract
OBJECTIVE This study was devised to translate Cystic Fibrosis Questionnaire-Revised to Hindi and administer it to Indian children and adolescents diagnosed with cystic fibrosis. DESIGN Cross-sectional study. SETTING This study was carried out in cystic fibrosis patients attending Pediatric Chest Clinic of a tertiary-care hospital in Northern India from July 2012 to December 2012. PARTICIPANTS 45 children (6-13 years) and their parents, and 14 adolescents. Patients with unstable health in the past two weeks were excluded. INTERVENTION Cystic Fibrosis Questionnaire- Revised translated in Hindi was administered. Clinical evaluation and scoring, throat swab cultures and spirometry were also done during the same visit. MAIN OUTCOME MEASURES Health Related Quality of Life scores were the primary measures, and clinical scores, swab cultures and spirometry were secondary measures. RESULTS Cronbachs alpha ranged from 0.020-0.863.The Factor analysis indicated that most test-items correlated more with competing scales than the intended scales. Convergence between self and proxy-rating was found to be dependent on the domain. The Cystic Fibrosis Questionnaire- Revised scores correlated well with clinical scores (r=0.65,P=0.011), Pseudomonas spp culture data and pulmonary function tests. There was an inverse relation between Health Related Quality of Life scores and age at diagnosis (r=-0.339, P=0.02). CONCLUSIONS Hindi versions of Cystic Fibrosis Questionnaire- Revised: Child, Adolescent and Parents instruments will act as an important step towards data on Health Related Quality of Life of Indian patients with cystic fibrosis.
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Abstract
Cystic fibrosis is an autosomal recessive, monogenetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The gene defect was first described 25 years ago and much progress has been made since then in our understanding of how CFTR mutations cause disease and how this can be addressed therapeutically. CFTR is a transmembrane protein that transports ions across the surface of epithelial cells. CFTR dysfunction affects many organs; however, lung disease is responsible for the vast majority of morbidity and mortality in patients with cystic fibrosis. Prenatal diagnostics, newborn screening and new treatment algorithms are changing the incidence and the prevalence of the disease. Until recently, the standard of care in cystic fibrosis treatment focused on preventing and treating complications of the disease; now, novel treatment strategies directly targeting the ion channel abnormality are becoming available and it will be important to evaluate how these treatments affect disease progression and the quality of life of patients. In this Primer, we summarize the current knowledge, and provide an outlook on how cystic fibrosis clinical care and research will be affected by new knowledge and therapeutic options in the near future. For an illustrated summary of this Primer, visit: http://go.nature.com/4VrefN.
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Alpern AN, Brumback LC, Ratjen F, Rosenfeld M, Davis SD, Quittner AL. Initial evaluation of the Parent Cystic Fibrosis Questionnaire—Revised (CFQ-R) in infants and young children. J Cyst Fibros 2015; 14:403-11. [DOI: 10.1016/j.jcf.2014.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
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A Systematic Review of Factors Associated with Health-Related Quality of Life in Adolescents and Adults with Cystic Fibrosis. Ann Am Thorac Soc 2015; 12:420-8. [DOI: 10.1513/annalsats.201408-393oc] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Carmody LA, Zhao J, Kalikin LM, LeBar W, Simon RH, Venkataraman A, Schmidt TM, Abdo Z, Schloss PD, LiPuma JJ. The daily dynamics of cystic fibrosis airway microbiota during clinical stability and at exacerbation. MICROBIOME 2015; 3:12. [PMID: 25834733 PMCID: PMC4381400 DOI: 10.1186/s40168-015-0074-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/24/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Recent work indicates that the airways of persons with cystic fibrosis (CF) typically harbor complex bacterial communities. However, the day-to-day stability of these communities is unknown. Further, airway community dynamics during the days corresponding to the onset of symptoms of respiratory exacerbation have not been studied. RESULTS Using 16S rRNA amplicon sequencing of 95 daily sputum specimens collected from four adults with CF, we observed varying degrees of day-to-day stability in airway bacterial community structures during periods of clinical stability. Differences were observed between study subjects with respect to the degree of community changes at the onset of exacerbation. Decreases in the relative abundance of dominant taxa were observed in three subjects at exacerbation. We observed no relationship between total bacterial load and clinical status and detected no viruses by multiplex PCR. CONCLUSION CF airway microbial communities are relatively stable during periods of clinical stability. Changes in microbial community structure are associated with some, but not all, pulmonary exacerbations, supporting previous observations suggesting that distinct types of exacerbations occur in CF. Decreased abundance of species that are dominant at baseline suggests a role for less abundant taxa in some exacerbations. Daily sampling revealed patterns of change in microbial community structures that may prove useful in the prediction and management of CF pulmonary exacerbations.
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Affiliation(s)
- Lisa A Carmody
- />Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - Jiangchao Zhao
- />Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - Linda M Kalikin
- />Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - William LeBar
- />Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - Richard H Simon
- />Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - Arvind Venkataraman
- />Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - Thomas M Schmidt
- />Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - Zaid Abdo
- />USDA-ARS, South Atlantic Area, Athens, GA USA
| | - Patrick D Schloss
- />Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109 USA
| | - John J LiPuma
- />Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109 USA
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Stern M, Bertrand DP, Bignamini E, Corey M, Dembski B, Goss CH, Pressler T, Rault G, Viviani L, Elborn JS, Castellani C. European Cystic Fibrosis Society Standards of Care: Quality Management in cystic fibrosis. J Cyst Fibros 2014; 13 Suppl 1:S43-59. [DOI: 10.1016/j.jcf.2014.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hebestreit H, Schmid K, Kieser S, Junge S, Ballmann M, Roth K, Hebestreit A, Schenk T, Schindler C, Posselt HG, Kriemler S. Quality of life is associated with physical activity and fitness in cystic fibrosis. BMC Pulm Med 2014; 14:26. [PMID: 24571729 PMCID: PMC3942299 DOI: 10.1186/1471-2466-14-26] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 02/19/2014] [Indexed: 12/04/2022] Open
Abstract
Background Health-related and disease-specific quality of life (HRQoL) has been increasingly valued as relevant clinical parameter in cystic fibrosis (CF) clinical care and clinical trials. HRQoL measures should assess – among other domains – daily functioning from a patient’s perspective. However, validation studies for the most frequently used HRQoL questionnaire in CF, the Cystic Fibrosis Questionnaire (CFQ), have not included measures of physical activity or fitness. The objective of this study was, therefore, to determine the cross-sectional and longitudinal relationships between HRQoL, physical activity and fitness in patients with CF. Methods Baseline (n = 76) and 6-month follow-up data (n = 70) from patients with CF (age ≥12 years, FEV1 ≥35%) were analysed. Patients participated in two multi-centre exercise intervention studies with identical assessment methodology. Outcome variables included HRQoL (German revised multi-dimensional disease-specific CFQ (CFQ-R)), body composition, pulmonary function, physical activity, short-term muscle power, and aerobic fitness by peak oxygen uptake and aerobic power. Results Peak oxygen uptake was positively related to 7 of 13 HRQoL scales cross-sectionally (r = 0.30-0.46). Muscle power (r = 0.25-0.32) and peak aerobic power (r = 0.24-0.35) were positively related to 4 scales each, and reported physical activity to 1 scale (r = 0.29). Changes in HRQoL-scores were directly and significantly related to changes in reported activity (r = 0.35-0.39), peak aerobic power (r = 0.31-0.34), and peak oxygen uptake (r = 0.26-0.37) in 3 scales each. Established associates of HRQoL such as FEV1 or body mass index correlated positively with fewer scales (all 0.24 < r < 0.55). Conclusions HRQoL was associated with physical fitness, especially aerobic fitness, and to a lesser extent with reported physical activity. These findings underline the importance of physical fitness for HRQoL in CF and provide an additional rationale for exercise testing in this population. Trial registration ClinicalTrials.gov, NCT00231686
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Affiliation(s)
- Helge Hebestreit
- Pediatric Department, University of Würzburg, Würzburg, Germany.
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