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Caley LR, Jarosz-Griffiths HH, Smith L, Gale L, Barrett J, Kinsey L, Davey V, Nash M, Jones AM, Whitehouse JL, Shimmin D, Floto RA, White H, Peckham DG. Body mass index and nutritional intake following Elexacaftor/Tezacaftor/Ivacaftor modulator therapy in adults with cystic fibrosis. J Cyst Fibros 2023; 22:1002-1009. [PMID: 37422432 DOI: 10.1016/j.jcf.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Elexacaftor/Tezacaftor/Ivacaftor (ETI) modulator therapy is often associated with increased body mass index (BMI) in people with cystic fibrosis (CF). This is thought to reflect improved clinical stability and increased appetite and nutritional intake. We explored the change in BMI and nutritional intake following ETI modulator therapy in adults with CF. METHODS Dietary intake, measured with myfood24®, and BMI were collected from adults with CF at baseline and follow-up as part of an observational study. Changes in BMI and nutritional intake in participants who commenced ETI therapy between time points were assessed. To contextualize findings, we also assessed changes in BMI and nutritional intake between study points in a group on no modulators. RESULTS In the pre and post ETI threapy group (n = 40), BMI significantly increased from 23.0 kg/m2 (IQR 21.4, 25.3) at baseline to 24.6 kg/m2 (IQR 23.0, 26.7) at follow-up (p<0.001), with a median of 68 weeks between time points (range 20-94 weeks) and median duration of ETI therapy was 23 weeks (range 7-72 weeks). There was a significant decrease in energy intake from 2551 kcal/day (IQR 2107, 3115) to 2153 kcal/day (IQR 1648, 2606), p<0.001. In the no modulator group (n = 10), BMI and energy intake did not significantly change between time points (p>0.05), a median of 28 weeks apart (range 20-76 weeks). CONCLUSIONS These findings tentatively suggest that the increase in BMI with ETI therapy may not simply be attributable to an increase in oral intake. Further exploration into the underlying aetiology of weight gain with ETI therapy is needed.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - L Smith
- Leeds Institute of Health Sciences, University Hospital, University of Leeds, UK
| | - L Gale
- Cambridge Centre for Lung Infection, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - J Barrett
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - L Kinsey
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - V Davey
- Dietetic Department, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - M Nash
- North East Essex Community Services, East Suffolk and North Essex NHS Foundation Trust, UK
| | - A M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - J L Whitehouse
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - D Shimmin
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R A Floto
- Cambridge Centre for Lung Infection, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - H White
- Leeds Beckett University, Nutrition, Health & Environment, Leeds, UK
| | - D G Peckham
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Caley LR, Zagoya C, Duckstein F, White H, Shimmin D, Jones AM, Barrett J, Whitehouse JL, Floto RA, Mainz JG, Peckham DG. Diabetes is associated with increased burden of gastrointestinal symptoms in adults with cystic fibrosis. J Cyst Fibros 2023; 22:275-281. [PMID: 36710099 DOI: 10.1016/j.jcf.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/09/2022] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Individuals with diabetes mellitus (DM) are known to frequently experience gastrointestinal (GI) symptoms. In contrast, the impact of cystic fibrosis-related diabetes (CFRD) on accentuating GI symptoms in people with cystic fibrosis (pwCF) is unknown. We sought to examine this. METHODS Abdominal symptoms were measured using the validated CF-specific GI symptom questionnaire - CFAbd-Score© - as part of a multicentre cohort study in pancreatic insufficient adults with CF, not on cystic fibrosis transmembrane conductance regulator (CFTR) modulators. The CFAbd-Score total score (0-100pts), its 5 domains, alongside nine specific GI symptoms associated with DM, were compared between the CFRD and non-CFRD groups. RESULTS 27 (31%) and 61 (69%) participants with CF were recruited in the CFRD and non-CFRD groups respectively. Total CFAbd-Score and the two domains: gastroesophageal reflux disease and disorders of appetite were significantly higher in the CFRD group compared to the non-CFRD group (p<0.05), with the mean total CFAbd-Score being 25.4 ± 2.5 and 18.4 ± 1.5 in the CFRD and non-CFRD groups respectively. Among the nine GI symptoms commonly reported as elevated in DM, bloating and nausea were significantly more common in individuals with CFRD compared to those without (p<0.05). CONCLUSIONS Individuals with CFRD overall, have a higher GI symptom burden, according to CFAbd-Scores. Specifically, they experience significantly more bloating and nausea. Close monitoring and further research is needed to better understand and manage GI symptoms in this group.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, United Kingdom.
| | - C Zagoya
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - F Duckstein
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - H White
- Nutrition, Health & Environment, Leeds Beckett University, Leeds, United Kingdom
| | - D Shimmin
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, United Kingdom
| | - J Barrett
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, United Kingdom
| | - J L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, United Kingdom
| | - R A Floto
- MRC-Laboratory of Molecular Biology, Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, United Kingdom; Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, United Kingdom
| | - J G Mainz
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany; Faculty of Health Sciences Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Germany
| | - D G Peckham
- Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, United Kingdom; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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3
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Webb K, Zain NMM, Stewart I, Fogarty A, Nash EF, Whitehouse JL, Smyth AR, Lilley AK, Knox A, Williams P, Cámara M, Bruce K, Barr HL. Porphyromonas pasteri and Prevotella nanceiensis in the sputum microbiota are associated with increased decline in lung function in individuals with cystic fibrosis. J Med Microbiol 2022; 71. [PMID: 35113780 PMCID: PMC8941952 DOI: 10.1099/jmm.0.001481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although anaerobic bacteria exist in abundance in cystic fibrosis (CF) airways, their role in disease progression is poorly understood. We hypothesized that the presence and relative abundance of the most prevalent, live, anaerobic bacteria in sputum of adults with CF were associated with adverse clinical outcomes. This is the first study to prospectively investigate viable anaerobic bacteria present in the sputum microbiota and their relationship with long-term outcomes in adults with CF. We performed 16S rRNA analysis using a viability quantitative PCR technique on sputum samples obtained from a prospective cohort of 70 adults with CF and collected clinical data over an 8 year follow-up period. We examined the associations of the ten most abundant obligate anaerobic bacteria present in the sputum with annual rate of FEV1 change. The presence of Porphyromonas pasteri and Prevotella nanceiensis were associated with a greater annual rate of FEV1 change; −52.3 ml yr−1 (95 % CI-87.7;−16.9), –67.9 ml yr−1 (95 % CI-115.6;−20.1), respectively. Similarly, the relative abundance of these live organisms were associated with a greater annual rate of FEV1 decline of −3.7 ml yr−1 (95 % CI: −6.1 to −1.3, P=0.003) and −5.3 ml yr−1 (95 % CI: −8.7 to −1.9, P=0.002) for each log2 increment of abundance, respectively. The presence and relative abundance of certain anaerobes in the sputum of adults with CF are associated with a greater rate of long-term lung function decline. The pathogenicity of anaerobic bacteria in the CF airways should be confirmed with further longitudinal prospective studies with a larger cohort of participants.
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Affiliation(s)
- Karmel Webb
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK
| | - Nur Masirah M Zain
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK.,Institute of Pharmaceutical Science, King's College London, UK
| | - Iain Stewart
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK.,Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK
| | - Edward F Nash
- West Midlands Adult CF Centre, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alan R Smyth
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew K Lilley
- Institute of Pharmaceutical Science, King's College London, UK
| | - Alan Knox
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK.,Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Paul Williams
- National Biofilms Innovation Centre, Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Miguel Cámara
- National Biofilms Innovation Centre, Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Kenneth Bruce
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK.,Institute of Pharmaceutical Science, King's College London, UK
| | - Helen L Barr
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, UK.,Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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4
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Nash EF, Choyce J, Carrolan V, Justice E, Shaw KL, Sitch A, Mistry H, Whitehouse JL. A prospective randomised controlled mixed-methods pilot study of home monitoring in adults with cystic fibrosis. Ther Adv Respir Dis 2022; 16:17534666211070133. [PMID: 35274585 PMCID: PMC8921750 DOI: 10.1177/17534666211070133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Home monitoring (HM) is able to detect more pulmonary exacerbations (PEx) than routine care (RC) in individuals with cystic fibrosis (CF), but there is currently no evidence for benefits in health outcomes. Patient experiences of using HM and a health economics assessment have not been rigorously assessed to date. This study aimed to assess the effects of HM on hospital admissions, quality of life, antibiotic requirements, exacerbation frequency, lung function, nutritional outcomes, anxiety, depression, costs and health outcomes, as well as the qualitative effects on the patient experience. METHODS This randomised controlled mixed-methods pilot study recruited CF adults cared for in one large regional CF centre. Participants were randomly allocated 1:1 to the intervention cohort [twice-weekly HM of symptoms measured by the Cystic Fibrosis Respiratory Symptom Diary - Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and forced expiratory volume in one second (FEV1)] or a control cohort (routine clinical care) for the 12-month study period. Measurements were recorded at study visits at baseline, 3, 6, 9 and 12 months. Spirometry, body weight, comorbidities, medications, hospital inpatient days, courses of antibiotics (oral and intravenous) and PEx (defined by the modified Fuchs criteria) were recorded at each study visit. Health status, capability and cost-effectiveness were measured at each study visit by the Hospital Anxiety and Depression Scale (HADS), the ICEpop CAPability measure for Adults (ICECAP-A), EuroQol 5 dimensions (EQ-5D-5L) questionnaire and an adapted resource use questionnaire. The patient experience of HM was assessed by semi-structured qualitative interviews at baseline and 12 months. RESULTS Eighty-eight participants were recruited, with 44 (50%) randomised to receive HM and 44 (50%) randomised to receive RC. Patient hospital inpatient bed days per annum and overall health-related quality of life were similar between the groups. Protocol-defined PEx requiring intravenous and oral antibiotics were detected more frequently in the HM group, with no other differences between the groups in the secondary outcomes. The total mean National Health Service (NHS) costs were approximately £1500 more per patient for the RC arm than the HM group. The qualitative analysis demonstrated that the patient experience of HM was generally positive and overall the intervention was well accepted. CONCLUSION The findings of this trial confirm that HM is effective in detecting PEx in adults with CF. There were no significant differences in hospital inpatient bed days and overall health-related quality of life between the groups. Despite the cost of the HM equipment and the salary of the research fellow to respond to the results, health economics analysis suggests the intervention was less expensive than RC. HM was generally well accepted, with most participants reporting that it resulted in them feeling more empowered and reassured. TRIAL REGISTRATION The study protocol was registered with Clinicaltrials.gov (NCT02994706) on 16 July 2014 and published in a peer reviewed journal.Data from this trial has been presented in abstract form at the ECFS Conference in Lyon in September 2020.
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Affiliation(s)
- Edward F Nash
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - Jocelyn Choyce
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Victoria Carrolan
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Edwin Justice
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karen L Shaw
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice Sitch
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Hema Mistry
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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5
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Barrett J, Slatter G, Whitehouse JL, Nash EF. Perception, experience and relationship with food and eating in adults with cystic fibrosis. J Hum Nutr Diet 2021; 35:757-764. [PMID: 34914145 DOI: 10.1111/jhn.12967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a multisystem disorder that primarily affects the respiratory and gastrointestinal systems. Dietetic therapy is a prominent aspect of CF management, with patients receiving nutritional surveillance and advice throughout their lifetime. The present study aimed to explore the perception, experience and relationship with food and eating in adults with CF. METHODS Semi-structured telephone interviews were conducted with nine adults with CF. Interviews were audio-recorded, transcribed verbatim and analysed thematically following a previously described six-phase procedure. RESULTS Six themes were identified: 'Sustained influence of eating experience in childhood', 'Eating for health: weight gain to prevent infection', 'Balancing health and body image', 'I'm different,' 'Strategies for managing food intake' and 'Support from family, friends and the CF Team'. Participants talked about the range of strategies they employ, with a focus on eating well and choosing high calorie foods being an important part of their health management strategy. This is driven by the belief that a good weight ensures better health and perceiving eating as a treatment. CONCLUSIONS This group felt able to cope well and had developed strategies to manage their dietary needs. Food experience was variable throughout their lifetime, with childhood experience having a sustained effect on adult eating behaviour. Weight gain, body image and dietary health implications are considerable concerns for patients. New CF transmembrane modulator treatments (CFTR modulators) are changing the dietary needs of this population. It is important that these issues are explored during dietetic consultations to identify barriers to dietary change.
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Affiliation(s)
- Joanne Barrett
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - Georgina Slatter
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - Joanna L Whitehouse
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - Edward F Nash
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
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6
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Zain NMM, Webb K, Stewart I, Halliday N, Barrett DA, Nash EF, Whitehouse JL, Honeybourne D, Smyth AR, Forrester DL, Knox AJ, Williams P, Fogarty A, Cámara M, Bruce KD, Barr HL. 2-Alkyl-4-quinolone quorum sensing molecules are biomarkers for culture-independent Pseudomonas aeruginosa burden in adults with cystic fibrosis. J Med Microbiol 2021; 70. [PMID: 34596013 DOI: 10.1099/jmm.0.001420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Pseudomonas aeruginosa produces quorum sensing signalling molecules including 2-alkyl-4-quinolones (AQs), which regulate virulence factor production in the cystic fibrosis (CF) airways.Hypothesis/Gap statement. Culture can lead to condition-dependent artefacts which may limit the potential insights and applications of AQs as minimally-invasive biomarkers of bacterial load.Aim. We aimed to use culture-independent methods to explore the correlations between AQ levels and live P. aeruginosa load in adults with CF.Methodology. Seventy-five sputum samples at clinical stability and 48 paired sputum samples obtained at the beginning and end of IV antibiotics for a pulmonary exacerbation in adults with CF were processed using a viable cell separation technique followed by quantitative P. aeruginosa polymerase chain reaction (qPCR). Live P. aeruginosa qPCR load was compared with the concentrations of three AQs (HHQ, NHQ and HQNO) detected in sputum, plasma and urine.Results. At clinical stability and the beginning of IV antibiotics for pulmonary exacerbation, HHQ, NHQ and HQNO measured in sputum, plasma and urine were consistently positively correlated with live P. aeruginosa qPCR load in sputum, compared to culture. Following systemic antibiotics live P. aeruginosa qPCR load decreased significantly (P<0.001) and was correlated with a reduction in plasma NHQ (plasma: r=0.463, P=0.003).Conclusion. In adults with CF, AQ concentrations correlated more strongly with live P. aeruginosa bacterial load measured by qPCR compared to traditional culture. Prospective studies are required to assess the potential of systemic AQs as biomarkers of P. aeruginosa bacterial burden.
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Affiliation(s)
- Nur Masirah M Zain
- Institute of Pharmaceutical Science, King's College London, London, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK
| | - Karmel Webb
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK.,Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Iain Stewart
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Nigel Halliday
- National Biofilms Innovation Centre, University of Nottingham Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - David A Barrett
- Centre for Analytical Bioscience, Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Edward F Nash
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Honeybourne
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alan R Smyth
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK.,Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Douglas L Forrester
- University of Queensland, Northside Clinical Unit, Brisbane, Queensland, Australia.,Thoracic Programme, The Prince Charles Hospital, Brisbane, Australia
| | - Alan J Knox
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK
| | - Paul Williams
- National Biofilms Innovation Centre, University of Nottingham Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Fogarty
- Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK.,Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Miguel Cámara
- National Biofilms Innovation Centre, University of Nottingham Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Kenneth D Bruce
- Institute of Pharmaceutical Science, King's College London, London, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK
| | - Helen L Barr
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Nottingham MRC Molecular Pathology Node, Nottingham, UK
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7
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Webb K, Cámara M, Zain NMM, Halliday N, Bruce KD, Nash EF, Whitehouse JL, Knox A, Forrester D, Smyth AR, Williams P, Fogarty A, Barr HL. Novel detection of specific bacterial quorum sensing molecules in saliva: Potential non-invasive biomarkers for pulmonary Pseudomonas aeruginosa in cystic fibrosis. J Cyst Fibros 2021; 21:626-629. [PMID: 34518117 DOI: 10.1016/j.jcf.2021.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Pseudomonas aeruginosa produces specific signalling molecules, 2-alkyl-4-quinolones (AQs) that are detectable in the sputum of adults with cystic fibrosis (CF) and who have pulmonary infection with this opportunistic pathogen. This study aimed to determine whether AQs could be detected in saliva of patients with CF and known infection with Pseudomonas aeruginosa. Saliva and sputum samples were obtained from 89 adults with CF and analyzed using liquid chromatography-tandem mass spectrometry. AQs were detected in 39/89 (43.8%) saliva samples and 70/77(90.9%) sputum samples. Salivary AQs had a sensitivity of 50% (95%CI; 37.8; 62.2), specificity of 100% (95%CI; 47.8; 100), when compared to a molecular microbiological measure of P. aeruginosa in sputum as measured using polymerase chain reaction. Specific AQs produced by P. aeruginosa can be detected in the saliva and warrant investigation as potential non-invasive biomarkers of pulmonary P. aeruginosa.
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Affiliation(s)
- Karmel Webb
- Division of Epidemiology and Public Health, Nottingham NIHR Biomedical Research Centre, University of Nottingham, City Hospital Campus, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
| | - Miguel Cámara
- National Biofilms Innovation Centre, Nottingham University Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Nur Masirah M Zain
- Institute of Pharmaceutical Science, King's College London, London, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Nigel Halliday
- National Biofilms Innovation Centre, Nottingham University Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Kenneth D Bruce
- Institute of Pharmaceutical Science, King's College London, London, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Edward F Nash
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Alan Knox
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Douglas Forrester
- Thoracic Programme, The Prince Charles Hospital, Brisbane, Australia; Nottingham MRC Molecular Pathology Node, UK
| | - Alan R Smyth
- School of Medicine, University of Nottingham, Nottingham, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Paul Williams
- National Biofilms Innovation Centre, Nottingham University Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, Nottingham NIHR Biomedical Research Centre, University of Nottingham, City Hospital Campus, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Helen L Barr
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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8
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Kempegowda P, Sunsoa H, Chandan JS, Quinn LM, Amrelia PM, Atta SN, Amir S, Teh YS, Chaudhry S, de Bray A, Rashid R, Whitehouse JL, Nash EF, Syed A. Retinopathy and microalbuminuria are common microvascular complications in cystic fibrosis-related diabetes. Ther Adv Endocrinol Metab 2020; 11:2042018820966428. [PMID: 35154634 PMCID: PMC8832295 DOI: 10.1177/2042018820966428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022] Open
Abstract
AIMS To study the prevalence of microvascular complications and renal changes associated with cystic fibrosis-related diabetes (CFRD). METHODS This retrospective cohort study was conducted at the West Midlands Adult Cystic Fibrosis centre, United Kingdom. Data regarding age, sex, microalbuminuria, retinopathy neuropathy, and biochemical results were collected for all people with CFRD who had an annual review from 1 January 2018 to 31 December 2018 at the centre. Descriptive statistics were analysed using STATAv15.1. RESULTS A total of 189 patients were included, of which 56.6% were male and median age (interquartile range) was 33 (27-39) years; 79.4% (150/189) had their annual review in 2018. Those with a biochemically impaired renal function numbered 7.2% (13/180) and 22.7% (32/141) had microalbuminuria; 17.2% (10/58) had diabetes related retinopathy. No one in our cohort had diabetic ulcers; however, 10.3% (13/126) had absent foot pulses. CONCLUSION We found a higher prevalence of microalbuminuria compared with retinopathy in a large cohort of cystic fibrosis adults. This study demonstrates the need for regular specialist follow-up to facilitate early identification of such complications and a long-term prospective cohort to understand underlying mechanisms.
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Affiliation(s)
| | - Harbinder Sunsoa
- West Midlands Adult CF Centre, University
Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joht S. Chandan
- Institute of Immunology and Immunotherapy,
University of Birmingham, Birmingham, UK
| | | | - Prashant M. Amrelia
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, UK
| | - Syed Noman Atta
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, UK
| | - Sidrah Amir
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, UK
| | - Yee Suh Teh
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, UK
| | - Sabba Chaudhry
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, UK
| | - Anne de Bray
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, UK
- Institute of Metabolism and Systems Research,
University of Birmingham, Birmingham, UK
| | - Rifat Rashid
- West Midlands Adult CF Centre, University
Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanna L. Whitehouse
- West Midlands Adult CF Centre, University
Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Edward F. Nash
- West Midlands Adult CF Centre, University
Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ateeq Syed
- Department of Diabetes and Endocrinology,
University Hospitals Birmingham NHS Foundation Trust, UK
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9
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Webb K, Fogarty A, Barrett DA, Nash EF, Whitehouse JL, Smyth AR, Stewart I, Knox A, Williams P, Halliday N, Cámara M, Barr HL. Clinical significance of Pseudomonas aeruginosa 2-alkyl-4-quinolone quorum-sensing signal molecules for long-term outcomes in adults with cystic fibrosis. J Med Microbiol 2019; 68:1823-1828. [PMID: 31671047 DOI: 10.1099/jmm.0.001099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction. Pseudomonas aeruginosa is an important respiratory pathogen in cystic fibrosis (CF), which is associated with an accelerated decline in lung function, frequent pulmonary exacerbations and increased mortality. P. aeruginosa produces intercellular signalling molecules including 2-alkyl-4-quinolones (AQs), which regulate virulence-factor production and biofilm formation in the CF airways. Studies have shown that AQs are detectable in the sputum and plasma of adults with CF and chronic pulmonary P. aeruginosa.Aim. We tested the hypothesis that the presence of six AQs in plasma or sputum obtained from adults with CF was associated with long-term adverse clinical outcomes.Methodology. We analysed clinical data over an 8 year follow period for 90 people with CF who had previously provided samples for AQ analysis at clinical stability. The primary outcome was all cause mortality or lung transplantation. Secondary outcomes were the rate of lung-function decline and the number of intravenous (IV) antibiotic days for pulmonary exacerbations.Results. There was no statistical association between the presence of any of the six measured AQs and the primary outcomes or the secondary outcome of decline in lung function. One of the six AQs was associated with IV antibiotic usage. The presence of 2-nonyl-3-hydroxy-4(1 h)-quinolone (C9-PQS) in sputum was associated with an increase in the number of IV antibiotic days in the follow-up period (Mann-Whitney; P=0.011).Conclusion. Further investigation to confirm the hypothesis that C9-PQS may be associated with increased antibiotic usage for pulmonary exacerbations is warranted as AQ-dependent signalling is a potential future target for anti-virulence therapies.
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Affiliation(s)
- Karmel Webb
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - David A Barrett
- Centre for Analytical Bioscience, Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Edward F Nash
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alan R Smyth
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Iain Stewart
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Alan Knox
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Paul Williams
- National Biofilms Innovation Centre, Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Nigel Halliday
- National Biofilms Innovation Centre, Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Miguel Cámara
- National Biofilms Innovation Centre, Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Helen L Barr
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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10
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Boyle M, Moore JE, Whitehouse JL, Bilton D, Downey DG. The diagnosis and management of respiratory tract fungal infection in cystic fibrosis: A UK survey of current practice. Med Mycol 2019; 57:155-160. [PMID: 29554296 DOI: 10.1093/mmy/myy014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/19/2018] [Indexed: 12/30/2022] Open
Abstract
Aspergillus fumigatus is commonly found in the airways of patients with cystic fibrosis (CF), and allergic bronchopulmonary aspergillosis (ABPA) is the most recognized associated clinical condition. However, accurate diagnosis remains challenging, and there is a paucity of clinical trials to guide clinical management of fungal disease. The aim of this survey was to assess the variability in current practice across the UK in diagnosis and management of fungal lung disease in CF patients. A 21 question anonymous online survey was sent to 94 paediatric and adult CF consultants in the UK. The response rate was 60.6% (32 adult physicians, 25 pediatricians) with 55 full and 2 partially completed surveys. For a first diagnosis of ABPA 20 (35.1%) treat with prednisolone alone, 38 (66.7%) use prednisolone with itraconazole and 2 (3.5%) choose voriconazole. Only 5 (8.8%) treat with prednisolone alone for a 1st relapse, 33 (58%) used prednisolone with itraconazole. To reduce treatment, 21 (36.8%) decrease steroids to zero over time and maintain azole therapy, 18 (31.6%) stop the azole and steroid after a fixed time, and 5 (8.8%) stop the azole after a fixed time and maintain a small steroid dose. Thirty-eight (66.7%) respondents believe Aspergillus colonization of the airway can cause clinical deterioration, and 37 (66.1%) would treat this. Scedosporium apiospermum infection has been diagnosed and treated by 35 (61.4%) of respondents. Results of this survey highlight the variance in clinical practice and the limited evidence available to guide management of fungal infection in CF.
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Affiliation(s)
- M Boyle
- Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - J E Moore
- Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | | | - D Bilton
- Royal Brompton Hospital, London, UK
| | - D G Downey
- Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, Northern Ireland, UK.,Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK
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11
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Barr HL, Halliday N, Barrett DA, Williams P, Forrester DL, Peckham D, Williams K, Smyth AR, Honeybourne D, Whitehouse JL, Nash EF, Dewar J, Clayton A, Knox AJ, Cámara M, Fogarty AW. Diagnostic and prognostic significance of systemic alkyl quinolones for P. aeruginosa in cystic fibrosis: A longitudinal study; response to comments. J Cyst Fibros 2017; 16:e21. [PMID: 29079141 DOI: 10.1016/j.jcf.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- H L Barr
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK.
| | - N Halliday
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - D A Barrett
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - P Williams
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - D L Forrester
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - D Peckham
- Leeds Adult Cystic Fibrosis Centre, St James's University Hospital, Leeds, UK
| | - K Williams
- Leeds Adult Cystic Fibrosis Centre, St James's University Hospital, Leeds, UK
| | - A R Smyth
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, UK
| | - D Honeybourne
- West Midlands Adult CF Centre, Heart of England, NHS Foundation Trust, Birmingham, UK
| | - J L Whitehouse
- West Midlands Adult CF Centre, Heart of England, NHS Foundation Trust, Birmingham, UK
| | - E F Nash
- West Midlands Adult CF Centre, Heart of England, NHS Foundation Trust, Birmingham, UK
| | - J Dewar
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Clayton
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A J Knox
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - M Cámara
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - A W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, University of Nottingham, Nottingham, UK
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12
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Choyce J, Shaw KL, Sitch AJ, Mistry H, Whitehouse JL, Nash EF. A prospective pilot study of home monitoring in adults with cystic fibrosis (HOME-CF): protocol for a randomised controlled trial. BMC Pulm Med 2017; 17:22. [PMID: 28114922 PMCID: PMC5256574 DOI: 10.1186/s12890-017-0366-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/11/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Home monitoring has the potential to detect early pulmonary exacerbations in people with cystic fibrosis (CF), with consequent improvements in health outcomes and healthcare associated costs. This study aims to assess the effects of home monitoring on hospital admissions, quality of life, antibiotic requirements, exacerbation frequency, lung function, nutritional outcomes, anxiety, depression, costs and health outcomes, as well as the qualitative effects on the patient experience. METHODS This randomised controlled mixed-methods trial aims to recruit 100 adults with CF cared for in one large regional CF centre. Participants are randomly allocated 1:1 to the intervention group (twice-weekly home monitoring of symptoms measured by the Cystic Fibrosis Respiratory Symptom Diary - Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and Forced Expiratory Volume in one second (FEV1)) or a control group (routine clinical care) for the 12-month study period. Measurements are recorded at study visits at baseline, 3, 6, 9 and 12 months. Spirometry, body weight, co-morbidities, medications, hospital inpatient days, courses of antibiotics (oral and intravenous), pulmonary exacerbations (defined by the modified Fuchs criteria) are recorded at each study visit. Health status, capability and health economics are measured at each study visit by the Hospital Anxiety and Depression Scale (HADS), the ICEpop CAPability measure for Adults (ICECAP-A), EuroQol 5 dimensions (EQ-5D-5L) questionnaire and an adapted resource use questionnaire. The patient experience is assessed by semi-structured qualitative interviews at baseline and 12 months. DISCUSSION Results from this study will help to determine the effect of home monitoring on inpatient bed days and quality of life in adults with CF, as well as other relevant health and health economic outcomes. TRIAL REGISTRATION This study protocol is registered with Clinicaltrials.gov ( NCT02994706 ), date registered 16th July 2014.
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Affiliation(s)
- Jocelyn Choyce
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Karen L. Shaw
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Alice J. Sitch
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Joanna L. Whitehouse
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Edward F. Nash
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
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13
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Keil C, Manzoor S, Gossain S, Hardy K, Whitehouse JL. P269 Acquisition of epidemic pseudomonas aeruginosa strains in non-cf bronchiectasis patients. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Barr HL, Halliday N, Barrett DA, Williams P, Forrester DL, Peckham D, Williams K, Smyth AR, Honeybourne D, L Whitehouse J, Nash EF, Dewar J, Clayton A, Knox AJ, Cámara M, Fogarty AW. Diagnostic and prognostic significance of systemic alkyl quinolones for P. aeruginosa in cystic fibrosis: A longitudinal study. J Cyst Fibros 2016; 16:230-238. [PMID: 27773591 PMCID: PMC5345566 DOI: 10.1016/j.jcf.2016.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/02/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Abstract
Background Pulmonary P. aeruginosa infection is associated with poor outcomes in cystic fibrosis (CF) and early diagnosis is challenging, particularly in those who are unable to expectorate sputum. Specific P. aeruginosa 2-alkyl-4-quinolones are detectable in the sputum, plasma and urine of adults with CF, suggesting that they have potential as biomarkers for P. aeruginosa infection. Aim To investigate systemic 2-alkyl-4-quinolones as potential biomarkers for pulmonary P. aeruginosa infection. Methods A multicentre observational study of 176 adults and 68 children with CF. Cross-sectionally, comparisons were made between current P. aeruginosa infection using six 2-alkyl-4-quinolones detected in sputum, plasma and urine against hospital microbiological culture results. All participants without P. aeruginosa infection at baseline were followed up for one year to determine if 2-alkyl-4-quinolones were early biomarkers of pulmonary P. aeruginosa infection. Results Cross-sectional analysis: the most promising biomarker with the greatest diagnostic accuracy was 2-heptyl-4-hydroxyquinoline (HHQ). In adults, areas under the ROC curves (95% confidence intervals) for HHQ analyses were 0.82 (0.75–0.89) in sputum, 0.76 (0.69–0.82) in plasma and 0.82 (0.77–0.88) in urine. In children, the corresponding values for HHQ analyses were 0.88 (0.77–0.99) in plasma and 0.83 (0.68–0.97) in urine. Longitudinal analysis: Ten adults and six children had a new positive respiratory culture for P. aeruginosa in follow-up. A positive plasma HHQ test at baseline was significantly associated with a new positive culture for P. aeruginosa in both adults and children in follow-up (odds ratio (OR) = 6.67;-95% CI:-1.48–30.1;-p = 0.01 and OR = 70; 95% CI: 5–956;-p < 0.001 respectively). Conclusions AQs measured in sputum, plasma and urine may be used to diagnose current infection with P. aeruginosa in adults and children with CF. These preliminary data show that plasma HHQ may have potential as an early biomarker of pulmonary P. aeruginosa. Further studies are necessary to evaluate if HHQ could be used in clinical practice to aid early diagnosis of P. aeruginosa infection in the future.
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Affiliation(s)
- Helen L Barr
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK.
| | - Nigel Halliday
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - David A Barrett
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Paul Williams
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - Douglas L Forrester
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Daniel Peckham
- Leeds Adult Cystic Fibrosis Centre, St James's University Hospital, Leeds, UK
| | - Kate Williams
- Leeds Adult Cystic Fibrosis Centre, St James's University Hospital, Leeds, UK
| | - Alan R Smyth
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, UK
| | - David Honeybourne
- West Midlands Adult CF Centre, Heart of England, NHS Foundation Trust, Birmingham, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, Heart of England, NHS Foundation Trust, Birmingham, UK
| | - Edward F Nash
- West Midlands Adult CF Centre, Heart of England, NHS Foundation Trust, Birmingham, UK
| | - Jane Dewar
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Clayton
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan J Knox
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Miguel Cámara
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, University of Nottingham, Nottingham, UK
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15
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Brown C, Choyce J, Rodgers N, Rashid R, Whitehouse JL, Smith EG, Nash EF. P233 Cough swabs should not be used to exclude non-tuberculous mycobacterial (NTM) infection in adults with cystic fibrosis. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Nash EF, Bradley H, Chapman E, Rashid R, Whitehouse JL. P281 The effectiveness of acupuncture in managing symptoms in CF adults. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Barr HL, Halliday N, Cámara M, Barrett DA, Williams P, Forrester DL, Simms R, Smyth AR, Honeybourne D, Whitehouse JL, Nash EF, Dewar J, Clayton A, Knox AJ, Fogarty AW. Pseudomonas aeruginosa quorum sensing molecules correlate with clinical status in cystic fibrosis. Eur Respir J 2015; 46:1046-54. [PMID: 26022946 PMCID: PMC4589431 DOI: 10.1183/09031936.00225214] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/08/2015] [Indexed: 01/25/2023]
Abstract
Pseudomonas aeruginosa produces quorum sensing signal molecules that are potential biomarkers for infection. A prospective study of 60 cystic fibrosis patients with chronic P. aeruginosa, who required intravenous antibiotics for pulmonary exacerbations, was undertaken. Clinical measurements and biological samples were obtained at the start and end of the treatment period. Additional data were available for 29 of these patients when they were clinically stable. Cross-sectionally, quorum sensing signal molecules were detectable in the sputum, plasma and urine of 86%, 75% and 83% patients, respectively. They were positively correlated between the three biofluids. Positive correlations were observed for most quorum sensing signal molecules in sputum, plasma and urine, with quantitative measures of pulmonary P. aeruginosa load at the start of a pulmonary exacerbation. Plasma concentrations of 2-nonyl-4-hydroxy-quinoline (NHQ) were significantly higher at the start of a pulmonary exacerbation compared to clinical stability (p<0.01). Following the administration of systemic antibiotics, plasma 2-heptyl-4-hydroxyquinoline (p=0.02) and NHQ concentrations (p<0.01) decreased significantly. In conclusion, quorum sensing signal molecules are detectable in cystic fibrosis patients with pulmonary P. aeruginosa infection and are positively correlated with quantitative measures of P. aeruginosa. NHQ correlates with clinical status and has potential as a novel biomarker for P. aeruginosa infection. P. aeruginosa QS molecules correlate with clinical status in cystic fibrosis and are biomarkers for infectionhttp://ow.ly/MhzZp
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Affiliation(s)
- Helen L Barr
- Division of Respiratory Medicine, Clinical Sciences Building, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Nigel Halliday
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - Miguel Cámara
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - David A Barrett
- Centre for Analytical Bioscience, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Paul Williams
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - Douglas L Forrester
- Division of Respiratory Medicine, Clinical Sciences Building, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Rebecca Simms
- Division of Respiratory Medicine, Clinical Sciences Building, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Alan R Smyth
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, University Hospital, Nottingham, UK
| | - David Honeybourne
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Edward F Nash
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jane Dewar
- Dept of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Clayton
- Dept of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan J Knox
- Division of Respiratory Medicine, Clinical Sciences Building, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Andrew W Fogarty
- Divison of Epidemiology and Public Health, Clinical Sciences Building, University of Nottingham, Nottingham, UK
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18
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Khiroya H, Pound R, Qureshi U, Brown C, Barrett J, Rashid R, Whitehouse JL, Turner AM, Nash EF. Physical activity in adults with cystic fibrosis receiving intravenous antibiotics in hospital and in the community. Open Respir Med J 2015; 9:15-21. [PMID: 25741394 PMCID: PMC4347052 DOI: 10.2174/1874306401509010015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 01/07/2023] Open
Abstract
Introduction : Intravenous antibiotic therapy (IVAT) for CF acute pulmonary exacerbations (APE) can be delivered in hospital or in the community. This study aimed to compare physical activity in CF patients receiving hospital and community-delivered IVAT, as well as other health outcomes. Materials and Methods : This was a non-randomised parallel group prospective observational study. Hospitalised and community-treated CF adults receiving IVAT for APE were asked to wear ActiGraph® activity monitors, complete the habitual activity estimation scale (HAES), food diary, modified shuttle test (MST) and CFQ-R at the start and end of therapy. Nutritional and clinical outcomes were also compared between the cohorts. The primary outcomes was physical activity measured by the ActiGraph® activity monitors at the beginning and end of treatment in both cohorts. Results : Physical activity (measured and self-reported) was no different between the cohorts, with both hospitalised and community-treated subjects being generally sedentary. Body weight increased significantly in the hospitalised cohort, whereas no difference was seen in the community-treated cohort. FEV1 % predicted and FVC % predicted increased in community-treated subjects, whereas only FVC % predicted increased in hospitalised subjects. CFQ-R respiratory domain increased to a greater extent in community-treated subjects. Conclusion : CF adults receiving IVAT for APE, both in hospital and in the community, are generally sedentary and we found no difference in physical activity between the two groups. These findings suggests the need to further promote physical activity in suitable patients during APE where considered appropriate.
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Affiliation(s)
- Heena Khiroya
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK ; School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rebecca Pound
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Ushna Qureshi
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Catherine Brown
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Joanne Barrett
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Rifat Rashid
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Joanna L Whitehouse
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK
| | - Alice M Turner
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Edward F Nash
- West Midlands Adult Cystic Fibrosis Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, B9 5SS, UK
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Brown CJ, Nash EF, Carrolan V, Rashid R, Whitehouse JL. P93 Clinical Outcomes and Patient Satisfaction Following Initiation of the TOBI Podhaler in CF Adults. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Carrolan V, Nash EF, Rashid R, Whitehouse JL. P92 A Retrospective Study to Evaluate the Use of Nebulised Meropenem at a Large UK Adult CF Centre: Abstract P92 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Mutagi A, Nash EF, Cameron S, Abbott G, Agostini P, Whitehouse JL, Honeybourne D, Boxall E. Microbial contamination of non-invasive ventilation devices used by adults with cystic fibrosis. J Hosp Infect 2012; 81:104-8. [PMID: 22579442 DOI: 10.1016/j.jhin.2012.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is currently little evidence regarding potential risks of bacterial contamination of non-invasive ventilation (NIV) devices used by cystic fibrosis (CF) patients. AIM The aim of this study was to determine the extent of bacterial contamination of NIV devices in our regional adult CF centre. METHODS Seven NIV devices recently used by CF patients chronically infected with Pseudomonas aeruginosa or Burkholderia cepacia complex (BCC) were swabbed in seven areas, both external and internal. Two devices had undergone ethylene oxide (EtO) sterilization between patient use and swabbing, and five devices had not undergone EtO sterilization. FINDINGS Swabs from five devices had insignificant growth of environmental organisms and two devices had significant growth of environmental organisms. No CF pathogens were isolated from any machine. CONCLUSIONS No evidence was found of pathogenic microbial contamination of NIV devices used by CF patients in this small study. We suggest that further studies examine for evidence of bacterial contamination of NIV devices and that this issue should be included in future CF infection control guidelines.
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Affiliation(s)
- A Mutagi
- Virology, Health Protection Agency, Microbiological Services, Heart of England NHS Foundation Trust, Birmingham, UK
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22
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Dowman JK, Watson D, Loganathan S, Gunson BK, Hodson J, Mirza DF, Clarke J, Lloyd C, Honeybourne D, Whitehouse JL, Nash EF, Kelly D, van Mourik I, Newsome PN. Long-term impact of liver transplantation on respiratory function and nutritional status in children and adults with cystic fibrosis. Am J Transplant 2012; 12:954-64. [PMID: 22225648 DOI: 10.1111/j.1600-6143.2011.03904.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Early liver transplant (LT) has been advocated for patients with cystic fibrosis liver disease (CFLD) and evidence of deterioration in nutritional state and respiratory function to prevent further decline. However, the impact of single LT on long-term respiratory function and nutritional status has not been adequately addressed. We performed a retrospective analysis of the outcomes of 40 (21 adult/19 pediatric) patients with CFLD transplanted between 1987 and 2009 with median follow-up of 47.8 months (range 4-180). One and five-year actuarial survival rates were 85%/64% for adult and 90%/85% for pediatric LT cohorts, respectively. Lung function remained stable until 4 years (FEV(1) % predicted; pretransplant 48.4% vs. 45.9%, 4 years posttransplant) but declined by 5 years (42.4%). Up to 4 years posttransplant mean annual decline in FEV(1) % was lower (0.74%; p = 0.04) compared with the predicted 3% annual decline in CF patients with comorbidity including diabetes. Number of courses of intravenous antibiotics was reduced following LT, from 3.9/year pretransplant to 1.1/year, 5 years posttransplant. Body mass index was preserved posttransplant; 18.0 kg/m(2) (range 15-24.3) pretransplant versus 19.6 kg/m(2) (range 16.4-22.7) 5 years posttransplant. In conclusion, LT is an effective treatment for selected patients with cirrhosis due to CFLD, stabilizing aspects of long-term lung function and preserving nutritional status.
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Affiliation(s)
- J K Dowman
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
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23
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Nash EF, Kavanagh D, Williams S, Bikmalla S, Gray A, Whitehouse JL. Implications of the current UK welfare reforms for adults with cystic fibrosis. Clin Med (Lond) 2011; 11:634. [PMID: 22268334 PMCID: PMC4952361 DOI: 10.7861/clinmedicine.11-6-634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Nash EF, Thomas A, Whitmill R, Rashid R, Barker B, Rayner RJ, Whitehouse JL, Honeybourne D. "Cepacia syndrome" associated with Burkholderia cepacia (Genomovar I) infection in an adolescent with cystic fibrosis. Pediatr Pulmonol 2011; 46:512-4. [PMID: 21194170 DOI: 10.1002/ppul.21404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Edward F Nash
- West Midlands Adult Cystic Fibrosis Centre, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK.
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25
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Nash EF, Whitmill R, Barker B, Rashid R, Whitehouse JL, Honeybourne D. Clinical outcomes of pandemic (H1N1) 2009 influenza (swine flu) in adults with cystic fibrosis. Thorax 2010; 66:259. [PMID: 20820065 DOI: 10.1136/thx.2010.140822] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Whitehouse JL, Exley AR, Foweraker J, Bilton D. Chronic Burkholderia multivorans bronchial infection in a non-cystic fibrosis individual with mannose binding lectin deficiency. Thorax 2005; 60:168-70. [PMID: 15681508 PMCID: PMC1747281 DOI: 10.1136/thx.2003.016493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The case history is presented of a woman with multiple respiratory infections and mannose binding lectin (MBL) deficiency but no evidence of bronchiectasis who developed a chronic Burkholderia multivorans infection. Careful microbiological assessment is needed in patients with recurrent respiratory infection and the presence of B multivorans should trigger further immunological investigation including assessment of MBL status.
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Affiliation(s)
- J L Whitehouse
- Lung Defence Clinic, Papworth Hospital, Papworth St Everard, Cambridgeshire CB3 8RE, UK.
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