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Kicic-Starcevich E, Hancock DG, Iosifidis T, Agudelo-Romero P, Caparros-Martin JA, Karpievitch YV, Silva D, Turkovic L, Le Souef PN, Bosco A, Martino DJ, Kicic A, Prescott SL, Stick SM. Airway epithelium respiratory illnesses and allergy (AERIAL) birth cohort: study protocol. Front Allergy 2024; 5:1349741. [PMID: 38666051 PMCID: PMC11043573 DOI: 10.3389/falgy.2024.1349741] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction Recurrent wheezing disorders including asthma are complex and heterogeneous diseases that affect up to 30% of all children, contributing to a major burden on children, their families, and global healthcare systems. It is now recognized that a dysfunctional airway epithelium plays a central role in the pathogenesis of recurrent wheeze, although the underlying mechanisms are still not fully understood. This prospective birth cohort aims to bridge this knowledge gap by investigating the influence of intrinsic epithelial dysfunction on the risk for developing respiratory disorders and the modulation of this risk by maternal morbidities, in utero exposures, and respiratory exposures in the first year of life. Methods The Airway Epithelium Respiratory Illnesses and Allergy (AERIAL) study is nested within the ORIGINS Project and will monitor 400 infants from birth to 5 years. The primary outcome of the AERIAL study will be the identification of epithelial endotypes and exposure variables that influence the development of recurrent wheezing, asthma, and allergic sensitisation. Nasal respiratory epithelium at birth to 6 weeks, 1, 3, and 5 years will be analysed by bulk RNA-seq and DNA methylation sequencing. Maternal morbidities and in utero exposures will be identified on maternal history and their effects measured through transcriptomic and epigenetic analyses of the amnion and newborn epithelium. Exposures within the first year of life will be identified based on infant medical history as well as on background and symptomatic nasal sampling for viral PCR and microbiome analysis. Daily temperatures and symptoms recorded in a study-specific Smartphone App will be used to identify symptomatic respiratory illnesses. Discussion The AERIAL study will provide a comprehensive longitudinal assessment of factors influencing the association between epithelial dysfunction and respiratory morbidity in early life, and hopefully identify novel targets for diagnosis and early intervention.
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Affiliation(s)
| | - David G. Hancock
- Wal-yan RespiratoryResearch Centre, Telethon Kids Institute, Perth, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Nedlands, WA, Australia
- School of Medicine, The University of Western Australia, Nedlands, WA, Australia
| | - Thomas Iosifidis
- Wal-yan RespiratoryResearch Centre, Telethon Kids Institute, Perth, WA, Australia
- School of Population Health, Curtin University, Bentley, WA, Australia
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine, The University of Western Australia, Nedlands, WA, Australia
| | - Patricia Agudelo-Romero
- Wal-yan RespiratoryResearch Centre, Telethon Kids Institute, Perth, WA, Australia
- European Virus Bioinformatics Centre, Jena, Germany
| | | | | | - Desiree Silva
- School of Medicine, The University of Western Australia, Nedlands, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
- Department of Paediatrics and Neonatology, Joondalup Health Campus, Joondalup, WA, Australia
- School of Medicine and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | | | - Peter N. Le Souef
- Wal-yan RespiratoryResearch Centre, Telethon Kids Institute, Perth, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Anthony Bosco
- School of Population Health, Curtin University, Bentley, WA, Australia
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
- Department of Immunobiology, The University of Arizona College of Medicine, Tucson, AZ, United States
| | - David J. Martino
- Wal-yan RespiratoryResearch Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Anthony Kicic
- Wal-yan RespiratoryResearch Centre, Telethon Kids Institute, Perth, WA, Australia
- School of Population Health, Curtin University, Bentley, WA, Australia
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine, The University of Western Australia, Nedlands, WA, Australia
| | - Susan L. Prescott
- School of Medicine, The University of Western Australia, Nedlands, WA, Australia
- European Virus Bioinformatics Centre, Jena, Germany
| | - Stephen M. Stick
- Wal-yan RespiratoryResearch Centre, Telethon Kids Institute, Perth, WA, Australia
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Nedlands, WA, Australia
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine, The University of Western Australia, Nedlands, WA, Australia
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Kicic-Starcevich E, Hancock DG, Iosifidis T, Agudelo-Romero P, Caparros-Martin JA, Silva D, Turkovic L, Le Souef PN, Bosco A, Martino DJ, Kicic A, Prescott SL, Stick SM. Airway Epithelium Respiratory Illnesses and Allergy (AERIAL) birth cohort: study protocol. medRxiv 2023:2023.04.29.23289314. [PMID: 37205501 PMCID: PMC10187351 DOI: 10.1101/2023.04.29.23289314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Introduction Recurrent wheezing disorders including asthma are complex and heterogeneous diseases that affect up to 30% of all children, contributing to a major burden on children, their families, and global healthcare systems. It is now recognized that a dysfunctional airway epithelium plays a central role in the pathogenesis of recurrent wheeze, although the underlying mechanisms are still not fully understood. This prospective birth cohort aims to bridge this knowledge gap by investigating the influence of intrinsic epithelial dysfunction on the risk for developing respiratory disorders and the modulation of this risk by maternal morbidities, in utero exposures, and respiratory exposures in the first year of life. Methods and Analysis The Airway Epithelium Respiratory Illnesses and Allergy (AERIAL) study is nested within the ORIGINS Project and will monitor 400 infants from birth to five years. The primary outcome of the AERIAL study will be the identification of epithelial endotypes and exposure variables that influence the development of recurrent wheezing, asthma, and allergic sensitisation. Nasal respiratory epithelium at birth to six weeks, one, three, and five years will be analysed by bulk RNA-seq and DNA methylation sequencing. Maternal morbidities and in utero exposures will be identified on maternal history and their effects measured through transcriptomic and epigenetic analyses of the amnion and newborn epithelium. Exposures within the first year of life will be identified based on infant medical history as well as on background and symptomatic nasal sampling for viral PCR and microbiome analysis. Daily temperatures and symptoms recorded in a study-specific Smartphone App will be used to identify symptomatic respiratory illnesses. Ethics and Dissemination Ethical approval has been obtained from Ramsey Health Care HREC WA-SA (#1908). Results will be disseminated through open-access peer-reviewed manuscripts, conference presentations, and through different media channels to consumers, ORIGINS families, and the wider community.
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Caudri D, Turkovic L, de Klerk NH, Rosenow T, Murray CP, Steyerberg EW, Ranganathan SC, Sly P, Stick SM, Breuer O. A screening tool to identify risk for bronchiectasis progression in children with cystic fibrosis. Pediatr Pulmonol 2022; 57:122-131. [PMID: 34596357 PMCID: PMC9292934 DOI: 10.1002/ppul.25712] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/26/2021] [Accepted: 09/23/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND The marked heterogeneity in cystic fibrosis (CF) disease complicates the selection of those most likely to benefit from existing or emergent treatments. OBJECTIVE We aimed to predict the progression of bronchiectasis in preschool children with CF. METHODS Using data collected up to 3 years of age, in the Australian Respiratory Early Surveillance Team for CF cohort study, clinical information, chest computed tomography (CT) scores, and biomarkers from bronchoalveolar lavage were assessed in a multivariable linear regression model as predictors for CT bronchiectasis at age 5-6. RESULTS Follow-up at 5-6 years was available in 171 children. Bronchiectasis prevalence at 5-6 was 134/171 (78%) and median bronchiectasis score was 3 (range 0-12). The internally validated multivariate model retained eight independent predictors accounting for 37% (adjusted R2 ) of the variance in bronchiectasis score. The strongest predictors of future bronchiectasis were: pancreatic insufficiency, repeated intravenous treatment courses, recurrent lower respiratory infections in the first 3 years of life, and lower airway inflammation. Dichotomizing the resulting prediction score at a bronchiectasis score of above the median resulted in a diagnostic odds ratio of 13 (95% confidence interval [CI], 6.3-27) with positive and negative predictive values of 80% (95% CI, 72%-86%) and 77% (95% CI, 69%-83%), respectively. CONCLUSION Early assessment of bronchiectasis risk in children with CF is feasible with reasonable precision at a group level, which can assist in high-risk patient selection for interventional trials. The unexplained variability in disease progression at individual patient levels remains high, limiting the use of this model as a clinical prediction tool.
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Affiliation(s)
- Daan Caudri
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Respiratory Medicine, Princess Margaret Hospital, Perth, Australia.,Department of Pediatrics/Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Lidija Turkovic
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Nicholas H de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Tim Rosenow
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Conor P Murray
- Department of Diagnostic Imaging, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarath C Ranganathan
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Peter Sly
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stephen M Stick
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Respiratory Medicine, Princess Margaret Hospital, Perth, Australia
| | - Oded Breuer
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Respiratory Medicine, Princess Margaret Hospital, Perth, Australia.,Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Ishak A, Stick SM, Turkovic L, Ranganathan SC, King L, Harrison J, Sly PD, Caudri D, Schultz A. BAL Inflammatory Markers Can Predict Pulmonary Exacerbations in Children With Cystic Fibrosis. Chest 2020; 158:2314-2322. [DOI: 10.1016/j.chest.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022] Open
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Breuer O, Schultz A, Turkovic L, de Klerk N, Keil AD, Brennan S, Harrison J, Robertson C, Robinson PJ, Sly PD, Ranganathan S, Stick SM, Caudri D. Reply to Turnbull et al. and to Hulme et al.. Am J Respir Crit Care Med 2020; 201:750-752. [PMID: 31769999 PMCID: PMC7068835 DOI: 10.1164/rccm.201911-2213le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Oded Breuer
- Telethon Kids InstitutePerth, Australia.,Perth Children's HospitalPerth, Australia.,Hadassah-Hebrew University Medical CenterJerusalem, Israel
| | - Andre Schultz
- Perth Children's HospitalPerth, Australia.,University of Western AustraliaPerth, Australia
| | | | | | - Anthony D Keil
- Perth Children's HospitalPerth, Australia.,PathWest Laboratory Medicine WAPerth, Australia
| | | | - Joanne Harrison
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Colin Robertson
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Philip J Robinson
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Peter D Sly
- The University of QueenslandBrisbane, Australiaand
| | - Sarath Ranganathan
- University of MelbourneMelbourne, Australia.,Murdoch Children's Research InstituteParkville, Australia.,Royal Children's HospitalParkville, Australia
| | - Stephen M Stick
- Perth Children's HospitalPerth, Australia.,University of Western AustraliaPerth, Australia
| | - Daan Caudri
- Telethon Kids InstitutePerth, Australia.,Perth Children's HospitalPerth, Australia.,Erasmus University Medical CenterRotterdam, the Netherlands
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Esther CR, Muhlebach MS, Ehre C, Hill DB, Wolfgang MC, Kesimer M, Ramsey KA, Markovetz MR, Garbarine IC, Forest MG, Seim I, Zorn B, Morrison CB, Delion MF, Thelin WR, Villalon D, Sabater JR, Turkovic L, Ranganathan S, Stick SM, Boucher RC. Mucus accumulation in the lungs precedes structural changes and infection in children with cystic fibrosis. Sci Transl Med 2020; 11:11/486/eaav3488. [PMID: 30944166 DOI: 10.1126/scitranslmed.aav3488] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/10/2019] [Indexed: 12/12/2022]
Abstract
Although destructive airway disease is evident in young children with cystic fibrosis (CF), little is known about the nature of the early CF lung environment triggering the disease. To elucidate early CF pulmonary pathophysiology, we performed mucus, inflammation, metabolomic, and microbiome analyses on bronchoalveolar lavage fluid (BALF) from 46 preschool children with CF enrolled in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) program and 16 non-CF disease controls. Total airway mucins were elevated in CF compared to non-CF BALF irrespective of infection, and higher densities of mucus flakes containing mucin 5B and mucin 5AC were observed in samples from CF patients. Total mucins and mucus flakes correlated with inflammation, hypoxia, and oxidative stress. Many CF BALFs appeared sterile by culture and molecular analyses, whereas other samples exhibiting bacterial taxa associated with the oral cavity. Children without computed tomography-defined structural lung disease exhibited elevated BALF mucus flakes and neutrophils, but little/no bacterial infection. Although CF mucus flakes appeared "permanent" because they did not dissolve in dilute BALF matrix, they could be solubilized by a previously unidentified reducing agent (P2062), but not N-acetylcysteine or deoxyribonuclease. These findings indicate that early CF lung disease is characterized by an increased mucus burden and inflammatory markers without infection or structural lung disease and suggest that mucolytic and anti-inflammatory agents should be explored as preventive therapy.
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Affiliation(s)
- Charles R Esther
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. .,Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Marianne S Muhlebach
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Camille Ehre
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - David B Hill
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Matthew C Wolfgang
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mehmet Kesimer
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kathryn A Ramsey
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
| | - Matthew R Markovetz
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ian C Garbarine
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - M Gregory Forest
- Departments of Mathematics, Biomedical Engineering, and Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ian Seim
- Departments of Mathematics, Biomedical Engineering, and Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bryan Zorn
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Cameron B Morrison
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Martial F Delion
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | - Juan R Sabater
- Department of Research, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, University of Melbourne, Parkville 3052, Australia
| | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Perth 6009, Australia.,Division of Paediatrics and Child Health, University of Western Australia, Perth 6009, Australia.,Princess Margaret Hospital for Children, Perth 6009, Australia
| | - Richard C Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Breuer O, Schultz A, Garratt LW, Turkovic L, Rosenow T, Murray CP, Karpievitch YV, Akesson L, Dalton S, Sly PD, Ranganathan S, Stick SM, Caudri D. Aspergillus Infections and Progression of Structural Lung Disease in Children with Cystic Fibrosis. Am J Respir Crit Care Med 2020; 201:688-696. [DOI: 10.1164/rccm.201908-1585oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Oded Breuer
- Telethon Kids Institute and
- Department of Pediatrics, Pediatric Pulmonary Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Respiratory and Sleep Medicine and
| | - Andre Schultz
- Telethon Kids Institute and
- Division of Child Health, Faculty of Medicine and Dentistry, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine and
| | | | | | - Tim Rosenow
- Telethon Kids Institute and
- Division of Child Health, Faculty of Medicine and Dentistry, University of Western Australia, Perth, Western Australia, Australia
| | - Conor P. Murray
- Department of Diagnostic Imaging, Perth Children’s Hospital, Perth, Western Australia, Australia
| | | | - Lauren Akesson
- Telethon Kids Institute and
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Samuel Dalton
- Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Peter D. Sly
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia; and
| | - Stephen M. Stick
- Telethon Kids Institute and
- Division of Child Health, Faculty of Medicine and Dentistry, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine and
| | - Daan Caudri
- Telethon Kids Institute and
- Department of Respiratory and Sleep Medicine and
- Department of Pediatrics/Respiratory Medicine, Erasmus Medical Center–Sophia, Rotterdam, the Netherlands
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Breuer O, Schultz A, Turkovic L, de Klerk N, Keil AD, Brennan S, Harrison J, Robertson C, Robinson PJ, Sly PD, Ranganathan S, Stick SM, Caudri D. Changing Prevalence of Lower Airway Infections in Young Children with Cystic Fibrosis. Am J Respir Crit Care Med 2020; 200:590-599. [PMID: 30811949 DOI: 10.1164/rccm.201810-1919oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 12/21/2022] Open
Abstract
Rationale: Historical studies suggest that airway infection in cystic fibrosis initiates with Staphylococcus aureus and Haemophilus influenzae, with later emergence of Pseudomonas aeruginosa. Aspergillus species are regarded as relatively infrequent, late-occurring infections.Objectives: To assess the prevalence and change in prevalence of early lower airway infections in a modern cohort of children with cystic fibrosis.Methods: All infants diagnosed with cystic fibrosis after newborn screening participating in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) cohort study between 2000 and 2018 were included. Participants prospectively underwent BAL at 3-6 months, 1 year, and annually up to 6 years of age. Lower airway infection prevalence was described. Changes in prevalence patterns were assessed longitudinally using generalized estimating equations controlling for age and repeated visits.Measurements and Main Results: A total of 380 infants underwent 1,759 BALs. The overall prevalence and median age of first acquisition of the most common infections were as follows: S. aureus, 11%, 2.5 years; P. aeruginosa, 8%, 2.4 years; Aspergillus species, 11%, 3.2 years; and H. influenzae, 9%, 3.1 years. During the study, a significant decrease in prevalence of P. aeruginosa (P < 0.001) and S. aureus (P < 0.001) was observed with a significant change toward more aggressive treatment. Prevalence of Aspergillus infections did not significantly change (P = 0.669).Conclusions: Aspergillus species and P. aeruginosa are commonly present in the lower airways from infancy. The decrease in prevalence of P. aeruginosa and S. aureus since 2000, coinciding with a more aggressive therapeutic approach, has resulted in Aspergillus becoming the most commonly isolated pathogen in young children. Further research is warranted to understand the implication of these findings.
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Affiliation(s)
- Oded Breuer
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Perth Children's Hospital, Perth, Australia
| | - Andre Schultz
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Division of Paediatric and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Australia
| | - Lidija Turkovic
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and
| | - Nicholas de Klerk
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and
| | - Anthony D Keil
- Perth Children's Hospital, Perth, Australia.,Department of Microbiology, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Siobhain Brennan
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and
| | - Joanne Harrison
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Colin Robertson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Philip J Robinson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia; and
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
| | - Stephen M Stick
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Division of Paediatric and Child Health, Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Perth Children's Hospital, Perth, Australia
| | - Daan Caudri
- Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.,Perth Children's Hospital, Perth, Australia.,Department of Pediatrics/Respiratory Medicine, Erasmus MC, Rotterdam, the Netherlands
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Turkovic L, Caudri D, Rosenow T, Breuer O, Murray C, Tiddens HA, Ramanauskas F, Ranganathan SC, Hall GL, Stick SM. Structural determinants of long-term functional outcomes in young children with cystic fibrosis. Eur Respir J 2020; 55:13993003.00748-2019. [DOI: 10.1183/13993003.00748-2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 02/12/2020] [Indexed: 11/05/2022]
Abstract
BackgroundAccelerated lung function decline in individuals with cystic fibrosis (CF) starts in adolescence with respiratory complications being the most common cause of death in later life. Factors contributing to lung function decline are not well understood, in particular its relationship with structural lung disease in early childhood. Detection and management of structural lung disease could be an important step in improving outcomes in CF patients.MethodsAnnual chest computed tomography (CT) scans were available from 2005 to 2016 as a part of the AREST CF cohort for children aged 3 months to 6 years. Annual spirometry measurements were available for 89.77% of the cohort (167 children aged 5–6 years) from age 5 to 15 years through outpatient clinics at Perth Children's Hospital (Perth, Australia) and The Royal Children's Hospital in Melbourne (Melbourne, Australia) (697 measurements, mean±sd age 9.3±2.1 years).ResultsChildren with a total CT score above the median at age 5–6 years were more likely to have abnormal forced expiratory volume in 1 s (FEV1) (adjusted hazard ratio 2.67 (1.06–6.72), p=0.037) during the next 10 years compared to those below the median chest CT score. The extent of all structural abnormalities except bronchial wall thickening were associated with lower FEV1 Z-scores. Mucus plugging and trapped air were the most predictive sub-score (adjusted mean change −0.17 (−0.26 – −0.07) p<0.001 and −0.09 (−0.14 – −0.04) p<0.001, respectively).DiscussionChest CT identifies children at an early age who have adverse long-term outcomes. The prevention of structural lung damage should be a goal of early intervention and can be usefully assessed with chest CT. In an era of therapeutics that might alter disease trajectories, chest CT could provide an early readout of likely long-term success.
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Rosenow T, Mok LC, Turkovic L, Berry LJ, Sly PD, Ranganathan S, Tiddens HA, Stick SM. The cumulative effect of inflammation and infection on structural lung disease in early cystic fibrosis. Eur Respir J 2019; 54:13993003.01771-2018. [DOI: 10.1183/13993003.01771-2018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/09/2019] [Indexed: 11/05/2022]
Abstract
IntroductionPulmonary inflammation and infection are important clinical and prognostic markers of lung disease in cystic fibrosis (CF). However, whether in young children they are transient findings or have cumulative, long-term impacts on respiratory health is largely unknown. We aimed to determine whether their repeated detection has a deleterious effect on structural lung disease.MethodsAll patients aged <6 years with annual computed tomography (CT) and bronchoalveolar lavage (BAL) were included. Structural lung disease on CT (%Disease) was determined using the PRAGMA-CF (Perth–Rotterdam Annotated Grid Morphometric Analysis for CF) method. The number of times free neutrophil elastase (NE) and infection were detected in BAL were counted, to determine cumulative BAL history. Linear mixed model analysis, accounting for repeat visits and adjusted for age, was used to determine associations.Results265 children (683 scans) were included for analysis, with BAL history comprising 1161 visits. %Disease was significantly associated with the number of prior NE (0.31, 95% CI 0.09–0.54; p=0.007) but not infection (0.23, 95% CI −0.01–0.47; p=0.060) detections. Reference equations were determined.ConclusionsPulmonary inflammation in surveillance BAL has a cumulative effect on structural lung disease extent, more so than infection. This provides a strong rationale for therapies aimed at reducing inflammation in young children.
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Gray DM, Czovek D, McMillan L, Turkovic L, Stadler JAM, Vanker A, Radics BL, Gingl Z, Hall GL, Sly PD, Zar HJ, Hantos Z. Intra-breath measures of respiratory mechanics in healthy African infants detect risk of respiratory illness in early life. Eur Respir J 2019; 53:13993003.00998-2018. [PMID: 30464010 PMCID: PMC7931666 DOI: 10.1183/13993003.00998-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/01/2018] [Indexed: 12/02/2022]
Abstract
Lower respiratory tract illness (LRTI) is a leading cause of mortality and morbidity in children. Sensitive and noninvasive infant lung function techniques are needed to measure risk for and impact of LRTI on lung health. The objective of this study was to investigate whether lung function derived from the intra-breath forced oscillation technique (FOT) was able to identify healthy infants at risk of LRTI in the first year of life. Lung function was measured with the novel intra-breath FOT, in 6-week-old infants in a South African birth cohort (Drakenstein Child Health Study). LRTI during the first year was confirmed by study staff. The association between baseline lung function and LRTI was assessed with logistic regression and odds ratios determined using optimal cut-off values. Of the 627 healthy infants with successful lung function testing, 161 (24%) had 238 LRTI episodes subsequently during the first year. Volume dependence of respiratory resistance (ΔR) and reactance (ΔX) was associated with LRTI. The predictive value was stronger if LRTI was recurrent (n=50 (31%): OR 2.5, ΔX), required hospitalisation (n=38 (16%): OR 5.4, ΔR) or was associated with wheeze (n=87 (37%): OR 3.9, ΔX). Intra-breath FOT can identify healthy infants at risk of developing LRTI, wheezing or severe illness in the first year of life. Novel measurements of respiratory mechanics are feasible in infants in a community setting and able to detect changes in lung function in healthy infants associated with increased risk of subsequent LRTI in infancyhttp://ow.ly/IUKk30mCfi3
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Affiliation(s)
- Diane M Gray
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.,These two authors are joint first authors
| | - Dorottya Czovek
- Child Health Research Centre, University of Queensland, Brisbane, Australia.,1st Dept of Paediatrics, Semmelweis University, Budapest, Hungary.,These two authors are joint first authors
| | - Lauren McMillan
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | | | - Jacob A M Stadler
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anessa Vanker
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Bence L Radics
- Dept of Pulmonology, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Dept of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Centre for Child Health, University of Western Australia, Perth, Australia
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Heather J Zar
- Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.,These two authors are joint senior authors
| | - Zoltán Hantos
- Dept of Pulmonology, University of Szeged, Szeged, Hungary.,Dept of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.,These two authors are joint senior authors
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12
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Abstract
INTRODUCTION Progressive lung disease is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Methods of correctly predicting the future progression of lung disease in patients with CF are essential for directing aggressive treatment to prevent loss of lung function and end stage respiratory failure. Areas covered: This review addresses predictors of respiratory disease progression in patients with CF. We searched Web of Science and Medline, with no restriction on publication date, with the search terms 'cystic fibrosis' and 'disease progression', 'lung function decline', 'prognosis', 'prediction/predictive', 'prediction/prognostic scores', 'risk factors', 'outcome measures/endpoints/disease surrogate', 'longitudinal/long term', 'statistical model', and 'survival'. Expert commentary: Forced expiratory volume in 1 sec (FEV1) and rate of FEV1 decline, remain the most significant predictors of mortality in patients with CF while CT scores and airway secretion biomarkers are the main predictors of early CF lung disease. Comprehensive scores incorporating clinical, lung function, imaging and laboratory data will become essential in the future for predicting disease progression and for use in clinical trials. Early interventions may delay the progression of structural lung disease.
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Affiliation(s)
- Oded Breuer
- a Telethon Kids Institute , University of Western Australia , Perth , Australia.,b Department of Respiratory and Sleep Medicine , Princess Margaret Hospital for Children , Perth , Australia
| | - Daan Caudri
- a Telethon Kids Institute , University of Western Australia , Perth , Australia.,b Department of Respiratory and Sleep Medicine , Princess Margaret Hospital for Children , Perth , Australia.,c Department of Pediatrics/Respiratory Medicine , Erasmus MC , Rotterdam , The Netherlands
| | - Stephen Stick
- a Telethon Kids Institute , University of Western Australia , Perth , Australia.,b Department of Respiratory and Sleep Medicine , Princess Margaret Hospital for Children , Perth , Australia
| | - Lidija Turkovic
- a Telethon Kids Institute , University of Western Australia , Perth , Australia
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13
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Montgomery ST, Dittrich AS, Garratt LW, Turkovic L, Frey DL, Stick SM, Mall MA, Kicic A. Interleukin-1 is associated with inflammation and structural lung disease in young children with cystic fibrosis. J Cyst Fibros 2018; 17:715-722. [PMID: 29884450 DOI: 10.1016/j.jcf.2018.05.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 11/17/2017] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the role of interleukin (IL)-1 in the pathogenesis of cystic fibrosis (CF) lung disease. This study investigated the relationship between IL-1 signalling, neutrophilic inflammation and structural lung changes in children with CF. METHODS Bronchoalveolar lavage fluid (BALf) from 102 children with CF were used to determine IL-1α, IL-1β, IL-8 levels and neutrophil elastase (NE) activity, which were then correlated to structural lung changes observed on chest computed tomography (CT) scans. RESULTS IL-1α and IL-1β were detectable in BAL in absence of infection, increased in the presence of bacterial infection and correlated with IL-8 (p < 0.0001), neutrophils (p < 0.0001) and NE activity (p < 0.01 and p < 0.001). IL-1α had the strongest association with structural lung disease (p < 0.01) in the absence of infection (uninfected: p < 0.01 vs. infected: p = 0.122). CONCLUSION Our data associates IL-1α with early structural lung damage in CF and suggests this pathway as a novel anti-inflammatory target.
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Affiliation(s)
- Samuel T Montgomery
- School of Paediatrics and Child Health, University of Western Australia, Nedlands 6009, Western Australia, Australia
| | - A Susanne Dittrich
- Department of Translational Pulmonology, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL),University of Heidelberg, Heidelberg, Germany; Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Luke W Garratt
- Telethon Kids Institute, University of Western Australia, Nedlands 6009, Western Australia, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Nedlands 6009, Western Australia, Australia
| | - Dario L Frey
- Department of Translational Pulmonology, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL),University of Heidelberg, Heidelberg, Germany; Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University Hospital Heidelberg, Heidelberg, Germany
| | - Stephen M Stick
- School of Paediatrics and Child Health, University of Western Australia, Nedlands 6009, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Nedlands 6009, Western Australia, Australia; Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth 6001, Western Australia, Australia; Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Nedlands 6009,Western Australia, Australia
| | - Marcus A Mall
- Department of Translational Pulmonology, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL),University of Heidelberg, Heidelberg, Germany; Department of Pediatric Pulmonology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Anthony Kicic
- School of Paediatrics and Child Health, University of Western Australia, Nedlands 6009, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Nedlands 6009, Western Australia, Australia; Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth 6001, Western Australia, Australia; Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Nedlands 6009,Western Australia, Australia; School of Public Health, Curtin University, Bentley 6102, Western Australia, Australia.
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- School of Paediatrics and Child Health, University of Western Australia, Nedlands 6009, Western Australia, Australia; Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth 6001, Western Australia, Australia; Murdoch Children's Research Institute, Parkville, 3052 Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, 3052 Melbourne, Victoria, Australia
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14
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Simpson SJ, Turkovic L, Wilson AC, Verheggen M, Logie KM, Pillow JJ, Hall GL. Lung function trajectories throughout childhood in survivors of very preterm birth: a longitudinal cohort study. Lancet Child Adolesc Health 2018; 2:350-359. [PMID: 30169268 DOI: 10.1016/s2352-4642(18)30064-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on longitudinal respiratory follow-up after preterm birth in the surfactant era are scarce and of increasing importance, with concerns that preterm survivors are destined for early onset chronic obstructive airway disease. We aimed to comprehensively assess lung function longitudinally from early childhood to mid-childhood in very preterm children (≤32 weeks gestation), and to explore factors negatively impacting on lung function trajectories. METHODS Preterm children (with and without bronchopulmonary dysplasia) and healthy term children as controls were studied. All preterm participants were born at 32 weeks' gestation or earlier at King Edward Memorial Hospital, Perth, WA, Australia, between 1997 and 2003. Bronchopulmonary dysplasia was defined as at least 28 days of supplemental oxygen requirement as assessed at 36 weeks' post-menstrual age. Spirometry, oscillatory mechanics, gas exchange, lung volumes, and respiratory symptoms were assessed at three visits, two in early childhood (4-8 years) and one in mid-childhood (9-12 years). CT of the chest was done in preterm children in mid-childhood. Respiratory symptoms were documented via questionnaire at each visit. Data were analysed longitudinally using linear mixed models. FINDINGS 200 very preterm children (126 with bronchopulmonary dysplasia and 74 without bronchopulmonary dysplasia) and 67 healthy term control children attended 458 visits between age 4 and 12 years. Chest CT was done on 133 preterm children at a mean age of 10·9 (SD 0·6) years. Preterm children, with and without bronchopulmonary dysplasia, had declines in spirometry z-scores over time compared with controls: forced expiratory volume in 1 s (FEV1), forced expiratory flow at 25-75% of the pulmonary volume, and FEV1/forced vital capacity all declined by at least 0·1 z-score per year in children with bronchopulmonary dysplasia (all p<0·001). Respiratory mechanics and gas exchange also deteriorated over time in children with bronchopulmonary dysplasia (relative to term controls, respiratory system reactance at 8 Hz decreased by -0·05 z-score per year [95% CI -0·08 to -0·01; p=0·006] and diffusing capacity of the lungs for carbon monoxide decreased by -0·03 z-score per year [95% CI -0·06 to -0·01; p=0·048]). Preterm children with bronchial wall thickening on chest CT (suggestive of inflammation) had bigger decreases in spirometry outcomes through childhood. For example, children with bronchial wall thickening on chest CT had an FEV1 z-score decline of -0·61 (95% CI -1·03 to-0·19; p=0·005) more than those without. Similarly, children exposed to tobacco smoke, those with earlier gestation, or those requiring more neonatal supplemental oxygen declined at a faster rate. INTERPRETATION Lung function trajectories are impaired in survivors of very preterm birth. Survivors with bronchopulmonary dysplasia, ongoing respiratory symptoms, or CT changes reflecting inflammation have the poorest trajectories and might be at increased risk of lung disease in later life. Close targeted pulmonary follow-up of these individuals is necessary. FUNDING National Health and Medical Research Council grants APP634519, APP1073301 (to SJS), APP1077691 (to JJP), and APP1025550 (to GLH), Princess Margret Hospital Foundation, and Raine Medical Foundation.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | | | - Andrew C Wilson
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Maureen Verheggen
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Karla M Logie
- Telethon Kids Institute, Perth, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - J Jane Pillow
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Graham L Hall
- Telethon Kids Institute, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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15
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Muhlebach MS, Zorn BT, Esther CR, Hatch JE, Murray CP, Turkovic L, Ranganathan SC, Boucher RC, Stick SM, Wolfgang MC. Initial acquisition and succession of the cystic fibrosis lung microbiome is associated with disease progression in infants and preschool children. PLoS Pathog 2018; 14:e1006798. [PMID: 29346420 PMCID: PMC5773228 DOI: 10.1371/journal.ppat.1006798] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 12/08/2017] [Indexed: 01/09/2023] Open
Abstract
The cystic fibrosis (CF) lung microbiome has been studied in children and adults; however, little is known about its relationship to early disease progression. To better understand the relationship between the lung microbiome and early respiratory disease, we characterized the lower airways microbiome using bronchoalveolar lavage (BAL) samples obtained from clinically stable CF infants and preschoolers who underwent bronchoscopy and chest computed tomography (CT). Cross-sectional samples suggested a progression of the lower airways microbiome with age, beginning with relatively sterile airways in infancy. By age two, bacterial sequences typically associated with the oral cavity dominated lower airways samples in many CF subjects. The presence of an oral-like lower airways microbiome correlated with a significant increase in bacterial density and inflammation. These early changes occurred in many patients, despite the use of antibiotic prophylaxis in our cohort during the first two years of life. The majority of CF subjects older than four harbored a pathogen dominated airway microbiome, which was associated with a further increase in inflammation and the onset of structural lung disease, despite a negligible increase in bacterial density compared to younger patients with an oral-like airway microbiome. Our findings suggest that changes within the CF lower airways microbiome occur during the first years of life and that distinct microbial signatures are associated with the progression of early CF lung disease. CF lung disease is characterized by persistent airway infection by complex microbial communities. These communities often consist of pathogens and endogenous microbes typically associated with the oral cavity. The development of these complex communities and their relationship to CF lung disease progression is unclear. To understand the evolution of the CF lower airways microbiome, we applied sensitive molecular detection methods to characterize the bacterial DNA sequences in bronchoalveolar lavage (BAL) samples obtained from clinically stable infants and preschoolers who underwent bronchoscopy. Our findings demonstrate that CF infants have relatively sterile lower airways with a progressive shift to a microbiome dominated by aerobic and anaerobic bacterial species commonly associated with the oral cavity. This initial acquisition of a lower airways microbiome was associated with a significant increase in bacterial burden and increased airway inflammation. Transition from an oral dominated to a pathogen dominated lower airways microbiome correlated with a further increase in inflammation and the onset of structural disease despite a negligible increase in bacterial density. Our findings suggest that oral microbes may play an important role in early CF airway disease and could potentially predispose subjects to subsequent infection by pathogens.
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Affiliation(s)
- Marianne S. Muhlebach
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Bryan T. Zorn
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Charles R. Esther
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph E. Hatch
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Conor P. Murray
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sarath C. Ranganathan
- Department of Respiratory Medicine, Royal Children’s Hospital, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
| | - Richard C. Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen M. Stick
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Matthew C. Wolfgang
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
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16
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Foong RE, Harper AJ, Skoric B, King L, Turkovic L, Davis M, Clem CC, Rosenow T, Davis SD, Ranganathan S, Hall GL, Ramsey KA. The clinical utility of lung clearance index in early cystic fibrosis lung disease is not impacted by the number of multiple-breath washout trials. ERJ Open Res 2018; 4:00094-2017. [PMID: 29707562 PMCID: PMC5912932 DOI: 10.1183/23120541.00094-2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/26/2017] [Accepted: 11/24/2017] [Indexed: 11/05/2022] Open
Abstract
The lung clearance index (LCI) from the multiple-breath washout (MBW) test is a promising surveillance tool for pre-school children with cystic fibrosis (CF). Current guidelines for MBW testing recommend that three acceptable trials are required. However, success rates to achieve these criteria are low in children aged <7 years and feasibility may improve with modified pre-school criteria that accepts tests with two acceptable trials. This study aimed to determine if relationships between LCI and clinical outcomes of CF lung disease differ when only two acceptable MBW trials are assessed. Healthy children and children with CF aged 3-6 years were recruited for MBW testing. Children with CF also underwent bronchoalveolar lavage fluid collection and a chest computed tomography scan. MBW feasibility increased from 46% to 75% when tests with two trials were deemed acceptable compared with tests where three acceptable trials were required. Relationships between MBW outcomes and markers of pulmonary inflammation, infection and structural lung disease were not different between tests with three acceptable trials compared with tests with two acceptable trials. This study indicates that pre-school MBW data from two acceptable trials may provide sufficient information on ventilation distribution if three acceptable trials are not possible.
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Affiliation(s)
- Rachel E. Foong
- Telethon Kids Institute, Subiaco, Australia
- The Hospital for Sick Children, Toronto, ON, Canada
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | | | - Billy Skoric
- Murdoch Children's Research Institute, Parkville, Australia
- Dept of Respiratory Medicine, The Royal Children's Hospital, Parkville, Australia
| | - Louise King
- Murdoch Children's Research Institute, Parkville, Australia
- Dept of Respiratory Medicine, The Royal Children's Hospital, Parkville, Australia
| | | | - Miriam Davis
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Dept of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Charles C. Clem
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Dept of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Stephanie D. Davis
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Dept of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarath Ranganathan
- Dept of Respiratory Medicine, The Royal Children's Hospital, Parkville, Australia
| | - Graham L. Hall
- Telethon Kids Institute, Subiaco, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Kathryn A. Ramsey
- Telethon Kids Institute, Subiaco, Australia
- Paediatric Respiratory Medicine, Inselspital, University of Bern, Bern, Switzerland
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17
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Caudri D, Turkovic L, Ng J, de Klerk NH, Rosenow T, Hall GL, Ranganathan SC, Sly PD, Stick SM. The association between Staphylococcus aureus and subsequent bronchiectasis in children with cystic fibrosis. J Cyst Fibros 2017; 17:462-469. [PMID: 29274943 DOI: 10.1016/j.jcf.2017.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 10/12/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Staphylococcus aureus (S. aureus) may be related to more rapid progression of cystic fibrosis (CF) lung disease. METHODS In the AREST CF cohort study, children diagnosed with CF undergo annual bronchoscopies with bronchoalveolar lavage and ultra-low-dose, chest computed tomography (CT) up to 6-years-old. Spirometry was assessed 3-monthly from the age of 4years. Associations between de novo S. aureus acquisition before school age and CT and lung function at ages 5-7years were investigated. Models were adjusted for multiple markers of disease severity at baseline. RESULTS De novo S. aureus acquisition at 3-years-old (n/N=12/122) was associated with increased bronchiectasis score at age 5-6years. This association decreased but remained significant after adjustment for confounders. S. aureus at 3 was associated with significantly reduced FEF25-75 at age 5-7years, but not with FEV1-%-predicted. CONCLUSION De novo S. aureus acquisition at age 3 is associated with later bronchiectasis and FEF25-75 in children with CF.
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Affiliation(s)
- Daan Caudri
- Telethon Kids Institute, Perth, Australia; Dept. of Respiratory Medicine, Princess Margaret Hospital, Perth, Australia; Dept. of Pediatrics/Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | | | - Jolyn Ng
- Telethon Kids Institute, Perth, Australia
| | | | | | - Graham L Hall
- Telethon Kids Institute, Perth, Australia; Centre of Child Health Research, The University of Western Australia, Perth, Australia; School of Physiotherapy and Exercise Science, Curtin University, Australia
| | - Sarath C Ranganathan
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stephen M Stick
- Telethon Kids Institute, Perth, Australia; Dept. of Respiratory Medicine, Princess Margaret Hospital, Perth, Australia
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18
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Kuo W, Soffers T, Andrinopoulou ER, Rosenow T, Ranganathan S, Turkovic L, Stick SM, Tiddens HAWM. Quantitative assessment of airway dimensions in young children with cystic fibrosis lung disease using chest computed tomography. Pediatr Pulmonol 2017; 52:1414-1423. [PMID: 28881106 DOI: 10.1002/ppul.23787] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate lung disease progression using airway and artery (AA) dimensions on chest CT over 2-year interval in young CF patients longitudinally and compare to disease controls cross-sectionally. METHODS Retrospective analysis of pressure controlled end-inspiratory CTs, 12 routine baseline (CT1 ) and follow up (CT2 ) from AREST CF cohort; 12 disease controls with normal CT. All visible AA-pairs were measured perpendicular to the airway axis. Inner and outer airway diameters and wall (outer-inner radius) thickness were divided by adjacent arteries to compute Ain A-, Aout A-, and AWT A-ratios, respectively. Differences between CF and control data were assessed using mixed effects models predicting AA-ratios per segmental generation (SG). Power calculations were performed with 80% power and ɑ = 0.05. RESULTS CF, median age CT1 2 years; CT2 3.9 years, 5 males. Controls, median age 2.9 years, 10 males. Total of 4798 AA-pairs measured. Cross-sectionally: Ain A-ratio showed no difference between controls and CF CT1 or CT2 . Aout A-ratio was significantly higher in CF CT1 (SG 2-4) and CT2 (SG 2-5) compared to controls. AWT A-ratio was increased for CF CT1 (SG 1-5) and CT2 (SG 2-6) compared to controls. CF longitudinally: Ain A-ratio was significantly higher at CT2 compared to CT1 . Increase in Aout A-ratio at CT2 compared to CT1 was visible in SG ≥4. Sample sizes of 21 and 58 would be necessary for 50% and 30% Aout A-ratio reductions, respectively, between CF CT2 and controls. CONCLUSION AA-ratio differences were present in young CF patients relative to disease controls. Aout A-ratio as an objective parameter for bronchiectasis could reduce sample sizes for clinical trials.
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Affiliation(s)
- Wieying Kuo
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Thomas Soffers
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Tim Rosenow
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Sarath Ranganathan
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Australia.,Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Stephen M Stick
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
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19
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Rosenow T, Ramsey K, Turkovic L, Murray CP, Mok LC, Hall GL, Stick SM. Air trapping in early cystic fibrosis lung disease-Does CT tell the full story? Pediatr Pulmonol 2017; 52:1150-1156. [PMID: 28682006 DOI: 10.1002/ppul.23754] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/05/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Mosaic attenuation on expiratory chest computed tomography (CT) is common in early life cystic fibrosis (CF) and often referred to as "air trapping". It is presumed to be localized hyperinflation due to small airway obstruction. In order to test this assumption, we compared air trapping extent to lung volumes measured on CT in young children with CF. MATERIALS AND METHODS Children aged below 7 years undergoing inspiratory/expiratory CT were recruited from the Australian Respiratory Early Surveillance Team for Cystic Fibrosis cohort. Automated lung segmentation was used to determine functional residual capacity (FRC), total lung capacity (TLC), and their ratio (FRC/TLC). Structural lung disease (%Disease) and air trapping (%TrappedAir) extent were assessed using PRAGMA-CF. Lung clearance index (LCI), an index of ventilation heterogeneity, was measured. Linear mixed model analysis was used to determine associations. RESULTS Seventy-three scans from 55 patients were obtained. %TrappedAir was associated with %Disease (0.19 [0.07, 0.31]; P = 0.003) and LCI (0.22 [0.04, 0.39]; P = 0.016), but not FRC/TLC (0.00 [-0.02, 0.02]; P = 0.931). DISCUSSION CT mosaic attenuation is associated with CF lung disease, however it is not always accompanied by physiologic hyperinflation. Other pathologies may contribute to mosaic attenuation. A better understanding of these factors could guide future therapies.
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Affiliation(s)
- Tim Rosenow
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.,Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Kathryn Ramsey
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Conor P Murray
- Diagnostic Imaging, Princess Margaret Hospital for Children, Perth, Australia
| | - L Clara Mok
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.,Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Graham L Hall
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Stephen M Stick
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.,Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Perth, Australia.,Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, Australia
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20
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Szczesniak R, Turkovic L, Andrinopoulou ER, Tiddens HAWM. Chest imaging in cystic fibrosis studies: What counts, and can be counted? J Cyst Fibros 2017; 16:175-185. [PMID: 28040479 PMCID: PMC5340596 DOI: 10.1016/j.jcf.2016.12.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND The dawn of precision medicine and CFTR modulators require more detailed assessment of lung structure in cystic fibrosis (CF) clinical studies. Various imaging markers have emerged and are measurable, but clarity is needed to identify what markers should count for clinical studies. High-resolution chest computed tomography (CT) scoring has yielded sensitive markers for the study of CF disease progression. Once completed, CT scores from ongoing randomized controlled trials can be used to examine relationships between imaging endpoints and therapeutic effectiveness. Similarly, Magnetic Resonance Imaging (MRI) is in development to generate structural as well as functional markers. RESULTS The aim of this review is to characterize the role of currently available CT and MRI markers in clinical studies, and to discuss study design, data processing and statistical challenges unique to these endpoints in CF studies. Suggestions to overcome these challenges in CF studies are included. CONCLUSIONS To maximize the potential of CT and MRI markers in clinical studies and advance treatment of CF disease progression, efforts should be made to conduct longitudinal randomized controlled trials including these modalities, develop data repositories, promote standardization and conduct reproducible research.
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Affiliation(s)
- Rhonda Szczesniak
- Division of Biostatistics & Epidemiology and Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | | | | | - Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology, The Netherlands; Department of Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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21
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D'Sylva P, Caudri D, Shaw N, Turkovic L, Douglas T, Bew J, Keil AD, Stick S, Schultz A. Induced sputum to detect lung pathogens in young children with cystic fibrosis. Pediatr Pulmonol 2017; 52:182-189. [PMID: 27905200 DOI: 10.1002/ppul.23636] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/17/2016] [Accepted: 10/25/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Induced sputum sampling holds promise as a method for obtaining samples representative of the lower airways in young children. Collection of induced sputum samples in young children differs from older children and adults' as pharyngeal suctioning is often required. Our aim was to determine the sensitivity and specificity of induced sputum with and without airway clearance techniques to detect lower airway pathogens in children less than age 7 with cystic fibrosis. METHODS Microbiological culture results were compared between 61 paired induced sputum and bronchoalveolar lavage fluid samples from young children with cystic fibrosis. The first cohort received no airway clearance and the second cohort received airway clearance. Induced sputum was sampled within 7 days of bronchoscopy. RESULTS Median age (range) of participants was 3.3 years (0.9-6.7). Sensitivity and specificity (95%CI) of induced sputum was 36.8% (16.3, 61.6), and 69% (52.9, 82.4), respectively (N = 61). In subgroup analysis, induced sputum with (N = 31) and without airway clearance (N = 30) demonstrated sensitivity of 50% (15.7, 84.3) and 27.3% (6.0, 61.0), respectively, and specificity of 60.9% (38.5, 80.3), and 78.9% (54.4, 93.9), respectively. CONCLUSION Induced sputum is not highly sensitive or specific as routine surveillance for detection of lower airway pathogens in young children with cystic fibrosis. Pediatr Pulmonol. 2017;52:182-189. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Pamela D'Sylva
- Department of Physiotherapy, Princess Margaret Hospital for Children, WA, Australia
| | - Daan Caudri
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, WA, Australia.,Telethon Kids Institute, The University of Western Australia, WA, Australia
| | - Nicole Shaw
- Telethon Kids Institute, The University of Western Australia, WA, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, The University of Western Australia, WA, Australia
| | - Tonia Douglas
- Telethon Kids Institute, The University of Western Australia, WA, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland, Australia
| | - Jane Bew
- Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, WA, Australia
| | - Anthony D Keil
- Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, WA, Australia
| | - Stephen Stick
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, WA, Australia.,Telethon Kids Institute, The University of Western Australia, WA, Australia.,School of Paediatrics and Child Health, The University of Western Australia, WA, Australia
| | - André Schultz
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, WA, Australia.,Telethon Kids Institute, The University of Western Australia, WA, Australia.,School of Paediatrics and Child Health, The University of Western Australia, WA, Australia
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22
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Gray DM, Turkovic L, Willemse L, Visagie A, Vanker A, Stein DJ, Sly PD, Hall GL, Zar HJ. Lung Function in African Infants in the Drakenstein Child Health Study. Impact of Lower Respiratory Tract Illness. Am J Respir Crit Care Med 2017; 195:212-220. [PMID: 27509359 PMCID: PMC5394784 DOI: 10.1164/rccm.201601-0188oc] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Lower respiratory tract illness is a major cause of childhood morbidity and mortality. It is unknown whether infants are predisposed to illness because of impaired lung function or whether respiratory illness reduces lung function. OBJECTIVES To investigate the impact of early life exposures, including lower respiratory tract illness, on lung function during infancy. METHODS Infants enrolled in the Drakenstein child health study had lung function at 6 weeks and 1 year. Testing during quiet natural sleep included tidal breathing, exhaled nitric oxide, and multiple breath washout measures. Risk factors for impaired lung health were collected longitudinally. Lower respiratory tract illness surveillance was performed and any episode investigated. MEASUREMENTS AND MAIN RESULTS Lung function was tested in 648 children at 1 year. One hundred and fifty (29%) infants had a lower respiratory tract illness during the first year of life. Lower respiratory tract illness was independently associated with increased respiratory rate (4%; 95% confidence interval [CI], 1.01-1.08; P = 0.02). Repeat episodes further increased respiratory rate (3%; 95% CI, 1.01-1.05; P = 0.004), decreased tidal volume (-1.7 ml; 95% CI, -3.3 to -0.2; P = 0.03), and increased the lung clearance index (0.13 turnovers; 95% CI, 0.04-0.22; P = 0.006) compared with infants without illness. Tobacco smoke exposure, lung function at 6 weeks, infant growth, and prematurity were other independent predictors of lung function at 1 year. CONCLUSIONS Early life lower respiratory tract illness impairs lung function at 1 year, independent of baseline lung function. Preventing early life lower respiratory tract illness is important to optimize lung function and promote respiratory health in childhood.
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Affiliation(s)
- Diane M. Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Lidija Turkovic
- Telethon Kids Institute and Centre for Child Health, University of Western Australia, Perth, Australia
| | - Lauren Willemse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Ane Visagie
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Peter D. Sly
- Children’s Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland and Queensland Children's Medical Research Institute, Brisbane, Australia; and
| | - Graham L. Hall
- Telethon Kids Institute and Centre for Child Health, University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and MRC Unit on Child and Adolescent Health, and
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23
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Esther CR, Turkovic L, Rosenow T, Muhlebach MS, Boucher RC, Ranganathan S, Stick SM. Metabolomic biomarkers predictive of early structural lung disease in cystic fibrosis. Eur Respir J 2016; 48:1612-1621. [PMID: 27836957 DOI: 10.1183/13993003.00524-2016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/27/2016] [Indexed: 12/21/2022]
Abstract
Neutrophilic airway inflammation plays a role in early structural lung disease in cystic fibrosis, but the mechanisms underlying this pathway are incompletely understood.Metabolites associated with neutrophilic inflammation were identified by discovery metabolomics on bronchoalveolar lavage fluid supernatant from 20 preschool children (2.9±1.3 years) with cystic fibrosis. Targeted mass-spectrometric detection of relevant metabolites was then applied to 34 children (3.5±1.5 years) enrolled in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) who underwent chest computed tomography and bronchoalveolar lavage from two separate lobes during 42 visits. Relationships between metabolites and localised structural lung disease were assessed using multivariate analyses.Discovery metabolomics identified 93 metabolites associated with neutrophilic inflammation, including pathways involved in metabolism of adenyl purines, amino acids and small peptides, cellular energy and lipids. In targeted mass spectrometry, products of adenosine metabolism, protein catabolism and oxidative stress were associated with structural lung disease and predicted future bronchiectasis, and activities of enzymes associated with adenosine metabolism were elevated in the samples with early disease.Metabolomics analyses revealed metabolites and pathways altered with neutrophilic inflammation and destructive lung disease. These pathways can serve as biomarkers and potential therapeutic targets for early cystic fibrosis lung disease.
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Affiliation(s)
- Charles R Esther
- Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA .,Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lidija Turkovic
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Tim Rosenow
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Marianne S Muhlebach
- Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard C Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, University of Melbourne, Parkville, Australia
| | - Stephen M Stick
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Australia
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24
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Ramsey KA, Hart E, Turkovic L, Padros-Goossens M, Stick SM, Ranganathan SC. Respiratory infection rates differ between geographically distant paediatric cystic fibrosis cohorts. ERJ Open Res 2016; 2:00014-2016. [PMID: 27957481 PMCID: PMC5140014 DOI: 10.1183/23120541.00014-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/02/2016] [Accepted: 07/26/2016] [Indexed: 11/10/2022] Open
Abstract
Respiratory infections are a major cause of pulmonary decline in children with cystic fibrosis (CF). We compared the prevalence of infection in early life at geographically distant CF treatment centres participating in the same surveillance programme in Australia. Lower airway microbiology, inflammation and structural lung disease at annual review were evaluated for 260 children 0–8 years old with CF at 1032 visits to CF treatment centres in Melbourne or Perth. Melbourne patients were more likely to be culture-positive for common respiratory pathogens at all age groups (odds ratio (OR) 1.85, 95% CI 1.33–2.58). Subjects <2 years old in Melbourne were also more likely to have neutrophil elastase present (OR 3.11, 95% CI 1.62–5.95). Bronchiectasis (OR 2.02, 95% CI 1.21–3.38) and air trapping (OR 2.53, 95% CI 1.42–4.51) in subjects 2–5 years old was more common in Melbourne subjects. The severity of structural lung disease was also worse in Melbourne patients >5 years old. Patients at both centres had a similar rate of hospitalisations and prescribed antibiotics. No procedural differences were identified that could explain the disparity between pathogen prevalence. Geographical differences in early acquisition of infection may contribute to variability in outcomes between CF centres. Infection rates different between two Australian paediatric cystic fibrosis patient cohortshttp://ow.ly/PAmG302IYL4
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Affiliation(s)
- Kathryn A Ramsey
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Cystic Fibrosis Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; These authors contributed equally to this paper
| | - Emily Hart
- Murdoch Children's Research Institute, Parkville, Australia; Dept of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia; These authors contributed equally to this paper
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Australia
| | - Sarath C Ranganathan
- Cystic Fibrosis Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Dept of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia; Dept of Paediatrics, The University of Melbourne, Parkville, Australia
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Shaw N, Le Souëf P, Turkovic L, McCahon L, Kicic A, Sly PD, Devadason S, Schultz A. Pressurised metered dose inhaler-spacer technique in young children improves with video instruction. Eur J Pediatr 2016; 175:1007-12. [PMID: 27251668 DOI: 10.1007/s00431-016-2738-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/16/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED The importance of good device technique to maximise delivery of aerosolised medications is widely recognised. Pressurised metered dose inhaler (pMDI)-spacer technique was investigated in 122 children, aged 2-7 years, with asthma. Eight individual steps of device technique were evaluated before and after viewing an instructional video for correct device technique. Video measurements were repeated every three months for nine months. Device technique improved directly after video instruction at the baseline study visit (p < 0.001) but had no immediate effect at subsequent visits. Additionally, pMDI-spacer technique improved with successive visits over one year for the group overall as evidenced by increases in the proportion of children scoring maximal (p = 0.02) and near-maximal (p = 0.04) scores. CONCLUSION Repeated video instruction over time improves inhaler technique in young children. WHAT IS KNOWN • Correct device technique is considered essential for sufficient delivery of inhaled medication. • Poor inhaler use is common in young asthmatic children using pressurised metered dose inhalers and spacers. What is New: • Video instruction could be used as a strategy to improve device technique in young children.
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Affiliation(s)
- Nicole Shaw
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008
| | - Peter Le Souëf
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia, 6008.,School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009
| | - Lidija Turkovic
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008
| | - Lucy McCahon
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008
| | - Anthony Kicic
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008.,Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia, 6008.,School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009.,Centre for Cell Therapy and Regenerative Medicine, The University of Western Australia and Harry Perkins Institute, Nedlands, Western Australia, Australia, 6009
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia, 4029
| | - Sunalene Devadason
- School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009
| | - André Schultz
- Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008. .,Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia, 6008. .,School of Paediatrics and Child Health, University of Western Australia, Nedlands, Western Australia, Australia, 6009.
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Ramsey KA, Rosenow T, Turkovic L, Skoric B, Banton G, Adams AM, Simpson SJ, Murray C, Ranganathan SC, Stick SM, Hall GL. Lung Clearance Index and Structural Lung Disease on Computed Tomography in Early Cystic Fibrosis. Am J Respir Crit Care Med 2016; 193:60-7. [PMID: 26359952 DOI: 10.1164/rccm.201507-1409oc] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE The lung clearance index is a measure of ventilation distribution derived from the multiple-breath washout technique. It has been suggested as a surrogate for chest computed tomography to detect structural lung abnormalities in individuals with cystic fibrosis (CF); however, the associations between lung clearance index and early structural lung disease are unclear. OBJECTIVES We assessed the ability of the lung clearance index to reflect structural lung disease on the basis of chest computed tomography across the entire pediatric age range. METHODS Lung clearance index was assessed in 42 infants (ages 0-2 yr), 39 preschool children (ages 3-6 yr), and 38 school-age children (7-16 yr) with CF before chest computed tomography and in 72 healthy control subjects. Scans were evaluated for CF-related structural lung disease using the Perth-Rotterdam Annotated Grid Morphometric Analysis for Cystic Fibrosis quantitative outcome measure. MEASUREMENTS AND MAIN RESULTS In infants with CF, lung clearance index is insensitive to structural disease (κ = -0.03 [95% confidence interval, -0.05 to 0.16]). In preschool children with CF, lung clearance index correlates with total disease extent. In school-age children, lung clearance index correlates with extent of total disease, bronchiectasis, and air trapping. In preschool and school-age children, lung clearance index has a good positive predictive value (83-86%) but a poor negative predictive value (50-55%) to detect the presence of bronchiectasis. CONCLUSIONS These data suggest that lung clearance index may be a useful surveillance tool to monitor structural lung disease in preschool and school-age children with CF. However, lung clearance index cannot replace chest computed tomography to screen for bronchiectasis in this population.
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Affiliation(s)
- Kathryn A Ramsey
- 1 Telethon Kids Institute and.,2 Cystic Fibrosis Research and Treatment Centre, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tim Rosenow
- 1 Telethon Kids Institute and.,3 School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
| | | | - Billy Skoric
- 4 Murdoch Children's Research Institute, Parkville, Australia.,5 Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
| | | | - Anne-Marie Adams
- 4 Murdoch Children's Research Institute, Parkville, Australia.,5 Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
| | | | | | - Sarath C Ranganathan
- 4 Murdoch Children's Research Institute, Parkville, Australia.,5 Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia.,7 Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Stephen M Stick
- 1 Telethon Kids Institute and.,8 Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Australia; and
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Rosenow T, Oudraad MCJ, Murray CP, Turkovic L, Kuo W, de Bruijne M, Ranganathan SC, Tiddens HAWM, Stick SM. Reply: Excess Risk of Cancer from Computed Tomography Scan Is Small but Not So Low as to Be Incalculable. Am J Respir Crit Care Med 2016; 192:1397-9. [PMID: 26623692 DOI: 10.1164/rccm.201508-1574le] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tim Rosenow
- 1 The University of Western Australia Perth, Australia
| | - Merel C J Oudraad
- 2 Erasmus MC-Sophia Children's Hospital Rotterdam, the Netherlands and.,3 University of Utrecht Utrecht, the Netherlands
| | - Conor P Murray
- 4 Princess Margaret Hospital for Children Perth, Australia
| | | | - Wieying Kuo
- 2 Erasmus MC-Sophia Children's Hospital Rotterdam, the Netherlands and.,5 Erasmus MC Rotterdam, the Netherlands and
| | - Marleen de Bruijne
- 5 Erasmus MC Rotterdam, the Netherlands and.,6 University of Copenhagen Copenhagen, Denmark
| | - Sarath C Ranganathan
- 7 Murdoch Children's Research Institute Melbourne, Australia.,8 Royal Children's Hospital Melbourne Melbourne, Australia.,9 University of Melbourne Melbourne, Australia
| | - Harm A W M Tiddens
- 2 Erasmus MC-Sophia Children's Hospital Rotterdam, the Netherlands and.,11 Erasmus MC Rotterdam, the Netherlands
| | - Stephen M Stick
- 1 The University of Western Australia Perth, Australia.,10 Princess Margaret Hospital for Children Perth, Australia
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Douglas T, Green J, Park J, Turkovic L, Massie J, Shields L. Psychosocial characteristics and predictors of health-care use in families of young children with cystic fibrosis in Western Australia. J Paediatr Child Health 2016; 52:34-9. [PMID: 26515431 DOI: 10.1111/jpc.13011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early childhood psychosocial experiences determine future health and health-care use. Identifying psychosocial predictors in cystic fibrosis may inform intervention strategies that can reduce health-care utilization. DESIGN The study was designed as a prospective cohort study. SETTING The study was set in the only cystic fibrosis clinic in Western Australia. PATIENTS The patients were children up to 6 years diagnosed with cystic fibrosis in Western Australia between 2005 and 2011. MAIN OUTCOME MEASURES Psychosocial data collected for each year of life were compared with Australian population data and analysed as predictors of annual hospital, emergency and outpatient visits. RESULTS Compared with the Australian population, cystic fibrosis families demonstrated lower socio-economic status and labour supply (P < 0.001), increased residential mobility (P < 0.001) and trends towards increased rates of parental separation (P = 0.066). Marital discord and maternal and child psychological stress significantly predicted increased hospital admissions, emergency and outpatient visits. CONCLUSIONS Social gradients may exist for families of young children with cystic fibrosis in Western Australia with potential implications for child health. Family psychological and relationship stress predicted increased child cystic fibrosis-related health-care use.
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Affiliation(s)
- Tonia Douglas
- Respiratory Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Schools of Psychology and Medical Education, Curtin University, Perth, Western Australia, Australia
| | - Jennifer Green
- Department of Paediatrics, Fiona Stanley Hospital, Joondalup Child Development Centre, Perth, Western Australia, Australia
| | - Judy Park
- Respiratory Department, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Lidija Turkovic
- Respiratory Department, Telethon Kids Institute, Perth, Western Australia, Australia
| | - John Massie
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Infection, Immunity and Environment, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Linda Shields
- Medical School, The University of Queensland, Brisbane, Queensland, Australia.,College of Healthcare Sciences, Tropical Health, Tropical Health Research Unit, Townsville Health District, James Cook University, Townsville, Queensland, Australia
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Ramsey KA, Ranganathan SC, Gangell CL, Turkovic L, Park J, Skoric B, Stick SM, Sly PD, Hall GL. Impact of lung disease on respiratory impedance in young children with cystic fibrosis. Eur Respir J 2015; 46:1672-9. [PMID: 26405283 DOI: 10.1183/13993003.00156-2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/14/2015] [Indexed: 11/05/2022]
Abstract
This study aimed to evaluate the ability of the forced oscillation technique (FOT) to detect underlying lung disease in preschool children with cystic fibrosis (CF) diagnosed following newborn screening.184 children (aged 3-6 years) with CF underwent lung function testing on 422 occasions using the FOT to assess respiratory resistance and reactance at the time of their annual bronchoalveolar lavage collection and chest computed tomography scan. We examined associations between FOT outcomes and the presence and progression of respiratory inflammation, infection and structural lung disease.Children with CF who had pronounced respiratory disease, including free neutrophil elastase activity, infection with pro-inflammatory pathogens and structural lung abnormalities had similar FOT outcomes to those children without detectable lung disease. In addition, the progression of lung disease over 1 year was not associated with worsening FOT outcomes.We conclude that the forced oscillation technique is relatively insensitive to detect underlying lung disease in preschool children with CF. However, FOT may still be of value in improving our understanding of the physiological changes associated with early CF lung disease.
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Affiliation(s)
- Kathryn A Ramsey
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia Cystic Fibrosis Research and Treatment Centre, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarath C Ranganathan
- Murdoch Childrens Research Institute, Parkville, Australia Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Catherine L Gangell
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia Queensland Children's Medical Research Institute, The University of Queensland, Herston, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Judy Park
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Billy Skoric
- Murdoch Childrens Research Institute, Parkville, Australia Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia
| | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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Simpson SJ, Ranganathan S, Park J, Turkovic L, Robins-Browne RM, Skoric B, Ramsey KA, Rosenow T, Banton GL, Berry L, Stick SM, Hall GL. Progressive ventilation inhomogeneity in infants with cystic fibrosis after pulmonary infection. Eur Respir J 2015; 46:1680-90. [PMID: 26381521 DOI: 10.1183/13993003.00622-2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 06/28/2015] [Indexed: 12/28/2022]
Abstract
Measures of ventilation distribution are promising for monitoring early lung disease in cystic fibrosis (CF). This study describes the cross-sectional and longitudinal impacts of pulmonary inflammation and infection on ventilation homogeneity in infants with CF.Infants diagnosed with CF underwent multiple breath washout (MBW) testing and bronchoalveolar lavage at three time points during the first 2 years of life.Measures were obtained for 108 infants on 156 occasions. Infants with a significant pulmonary infection at the time of MBW showed increases in lung clearance index (LCI) of 0.400 units (95% CI 0.150-0.648; p=0.002). The impact was long lasting, with previous pulmonary infection leading to increased ventilation inhomogeneity over time compared to those who remained free of infection (p<0.05). Infection with Haemophilus influenzae was particularly detrimental to the longitudinal lung function in young children with CF where LCI was increased by 1.069 units for each year of life (95% CI 0.484-1.612; p<0.001).Pulmonary infection during the first year of life is detrimental to later lung function. Therefore, strategies aimed at prevention, surveillance and eradication of pulmonary pathogens are paramount to preserve lung function in infants with CF.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Judy Park
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Roy M Robins-Browne
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Billy Skoric
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Kathryn A Ramsey
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Tim Rosenow
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Georgia L Banton
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Luke Berry
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, Australia School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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Rosenow T, Oudraad MCJ, Murray CP, Turkovic L, Kuo W, de Bruijne M, Ranganathan SC, Tiddens HAWM, Stick SM. PRAGMA-CF. A Quantitative Structural Lung Disease Computed Tomography Outcome in Young Children with Cystic Fibrosis. Am J Respir Crit Care Med 2015; 191:1158-65. [DOI: 10.1164/rccm.201501-0061oc] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zaloumis SG, Allen KJ, Bertalli NA, Turkovic L, Delatycki MB, Nicoll AJ, McLaren CE, English DR, Hopper JL, Giles GG, Anderson GJ, Olynyk JK, Powell LW, Gurrin LC. Natural history of HFE simple heterozygosity for C282Y and H63D: a prospective 12-year study. J Gastroenterol Hepatol 2015; 30:719-25. [PMID: 25311314 PMCID: PMC4782752 DOI: 10.1111/jgh.12804] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The risk of hemochromatosis-related morbidity for HFE simple heterozygosity for either the C282Y or H63D substitutions in the HFE protein was assessed using a prospective community-based cohort study. METHODS HFE genotypes were measured for 31,192 persons of northern European descent, aged between 40 and 69 years when recruited to the Melbourne Collaborative Cohort Study, and subjects were followed for an average of 12 years. For a random sample of 1438 participants stratified according to HFE genotype, two sets of biochemical iron indices performed 12 years apart and, at follow-up only, the presence/absence of six disease features associated with hereditary hemochromatosis were obtained. Summary data for 257 (139 female) C282Y simple heterozygotes and 123 (74 female) H63D simple heterozygotes were compared with 330 (181 female) controls with neither HFE mutation. RESULTS At baseline, mean transferrin saturation (TS) (95% confidence interval) and prevalence of TS > 55% were 35.14% (33.25, 37.04) and 3/112 (3%), 33.03% (29.9, 36.15) and 0/39 (0%), and 29.67% (27.93, 31.4) and 3/135 (2%) for C282Y, H63D and wild-type male participants, respectively. At follow-up, mean TS levels remained similar to baseline levels for both men and women irrespective of simple heterozygosity for either mutation. No HFE C282Y or H63D simple heterozygotes had documented iron overload (based on hepatic iron measures or serum ferritin greater than 1000 mg/L at baseline with documented therapeutic venesection). CONCLUSION No documented iron overload was observed for HFE simple heterozygotes for either C282Y or H63D, and morbidity for both HFE simple heterozygote groups was similar to that of HFE wild-type participants.
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Affiliation(s)
- Sophie G. Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Katrina J. Allen
- Murdoch Childrens Research Institute, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Victoria, Australia,Department of Gastroenterology, Royal Children's Hospital, Victoria, Australia
| | | | - Lidija Turkovic
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Martin B. Delatycki
- Murdoch Childrens Research Institute, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Victoria, Australia,Austin Health, Heidelberg, Victoria, Australia
| | | | | | - Dallas R. English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - John L. Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Graham G. Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Greg J. Anderson
- QIMR Berghofer Medical Research Institute and The University of Queensland, Brisbane, Australia
| | - John K. Olynyk
- Department of Gastroenterology, Fremantle Hospital, Fremantle, Australia; School of Medicine and Pharmacology, University of Western Australia, Nedlands, Australia; Western Australian Institute of Medical Research, Perth, Australia
| | - Lawrie W. Powell
- QIMR Berghofer Medical Research Institute and The University of Queensland, Brisbane, Australia,The University of Queensland and the Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Lyle C. Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
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Gurrin LC, Turkovic L. COMBINING INDIVIDUAL PARTICIPANT DATA AND SUMMARY STATISTICS FROM BOTH CONTINUOUSLY VALUED AND BINARY VARIABLES TO ESTIMATE REGRESSION PARAMETERS. AUST NZ J STAT 2012. [DOI: 10.1111/j.1467-842x.2012.00647.x] [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: 11/30/2022]
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Bertalli NA, Allen KJ, McLaren CE, Turkovic L, Osborne NJ, Constantine CC, Delatycki MB, English DR, Giles GG, Hopper JL, Anderson GJ, Olynyk JK, Powell LW, Gurrin LC. A comparison of self-reported and record-linked blood donation history in an Australian cohort. Transfusion 2011; 51:2189-98. [PMID: 21985049 DOI: 10.1111/j.1537-2995.2011.03141.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Questionnaire-based studies investigating blood donation history rely on the accurate recall of information from participants for results to be valid. This study aimed to retrieve electronic records from a national blood donation service and link them to self-reported history of donation to assess agreement between the two sources. STUDY DESIGN AND METHODS Between 2004 and 2006, a sample of participants of northern European descent was selected from the Melbourne Collaborative Cohort Study (n = 31,192) to participate in the "HealthIron" study (n = 1438). A total of 1052 participants completed questionnaires that included questions about blood donation history. In 2009, consenting participants' records were linked to the Australian Red Cross Blood Service (ARCBS) to provide information on blood donations made between 1980 and follow-up (2004-2006). Those who commenced blood donation before 1980 were excluded. RESULTS A total of 718 participants were available for analysis. Of these, 394 (55%) provided signed consent, including 182 (82%) of the 227 participants who self-reported ever donating blood. The two data sources were concordant for 331 (87%) of participants, with a κ statistic of 0.74 (SE, 0.05) indicating a high level of agreement. Participants tended to overstate by a factor of 2.0 (95% confidence interval, 1.7-2.2) the number of donations they had made when compared with ARCBS records. CONCLUSION Participants in studies assessing self-reported blood donation history are likely to correctly indicate whether or not they have ever donated blood. Quantitative estimates are potentially inaccurate and could benefit from validating a sample of records to quantify the bias.
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Affiliation(s)
- Nadine A Bertalli
- Centre for MEGA Epidemiology, School of Population Health, The University of Melbourne, Australia
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Turkovic L, Gurrin LC, Bahlo M, Dite GS, Southey MC, Hopper JL. Comparing the frequency of common genetic variants and haplotypes between carriers and non-carriers of BRCA1 and BRCA2 deleterious mutations in Australian women diagnosed with breast cancer before 40 years of age. BMC Cancer 2010; 10:466. [PMID: 20807450 PMCID: PMC2940805 DOI: 10.1186/1471-2407-10-466] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 09/01/2010] [Indexed: 11/26/2022] Open
Abstract
Background BRCA1 and BRCA2 mutations are found in a proportion of families with multiple early-onset breast cancers. There are a large number of different deleterious mutations in both genes, none of which would be detectable using standard genetic association studies. Single common variants and haplotypes of common variants may capture groups of deleterious mutations since some low prevalence haplotypes of common variants occur more frequently among chromosomes that carry rare, deleterious mutations than chromosomes that do not. Methods DNA sequence data for BRCA1 and BRCA2 was obtained from 571 participants from the Australian Breast Cancer Family Study. Genetic variants were classified as either deleterious mutations or common genetic variants. Variants tagging common polymorphisms were selected and haplotypes resolved using Haploview. Their frequency was compared to those with and without deleterious mutations using a permutation test. Results A common genetic variant in BRCA1 (3232A > G) was found to be over-represented in deleterious mutation carriers (p = 0.05), whereas a common genetic variant in BRCA2 (1342A > C) occurred less frequently in deleterious mutation carriers (p = 0.04). All four of the common BRCA1 variants used to form haplotypes occurred more frequently in the deleterious mutation carriers when compared to the non-carriers, but there was no evidence of a difference in the distributions between the two groups (p = 0.34). In BRCA2, all four common variants were found to occur less frequently in the deleterious mutation carriers when compared to non-carriers, but the evidence for difference in the distribution between the two groups was weak (p = 0.16). Several less common haplotypes of common BRCA1 variants were found to be over-represented among deleterious mutation carriers but there was no evidence for this at the population level. In BRCA2, only the most common haplotype was found to occur more frequently in deleterious mutation carriers, with again no evidence at the population level. Conclusions We observed differences in the frequency of common genetic variants of the BRCA1 and BRCA2 and their haplotypes between early-onset breast cancer cases who did and did not carry deleterious mutations in these genes. Although our data provide only weak evidence for a difference in frequencies at the population level, the number of deleterious mutation carriers was low and the results may yet be substantiated in a larger study using pooled data.
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Affiliation(s)
- Lidija Turkovic
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Victoria 3010, Australia.
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