scholarly journals Procalcitonin predicts the severity of cystic fibrosis pulmonary exacerbations and readmissions in adult patients: a prospective cohort study

2020 ◽  
Vol 68 (4) ◽  
pp. 856-863
Author(s):  
Kristina L Bailey ◽  
Peter J Murphy ◽  
Olena K Lineberry ◽  
Matthew R Haack ◽  
John D Dickinson ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Antibiotic Treatment ◽  
Hospital Admissions ◽  
Clinical Care ◽  
Forced Expiratory Volume ◽  
Pulmonary Exacerbation ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Pulmonary Exacerbations ◽  
Time Of Admission

Patients with cystic fibrosis (CF) experience multiple pulmonary exacerbations throughout their lifetime, resulting in repeated antibiotic exposure and hospital admissions. Reliable diagnostic markers to guide antibiotic treatment in patients with CF, however, are lacking. Given that the CF airway is characterized by persistent and frequent bacterial infection, our goal was to determine if procalcitonin (PCT) could be used as a severity and prognostic marker of CF exacerbation. We enrolled 40 participants at the time of diagnosis of CF pulmonary exacerbation. Inclusion criteria: age ≥19 years with exacerbation requiring antibiotics as determined by the treating physician. Exclusion criteria: antibiotics initiated more than 48 hours prior to enrollment, and pregnancy. Blood samples were collected on enrollment day and after 7–10 days of treatment. Of the 40 patients enrolled, 23 (57.5%) had detectable levels of PCT (≥0.05 ng/mL). PCT levels were significantly associated with pulmonary exacerbation scores (p=0.01) and per cent decrease in forced expiratory volume in 1 second (FEV1) (p=0.01) compared with the best in the last 12 months. Those who had worsening PCT during treatment had less improvement in FEV1 (p=0.001) and were more likely to be readmitted to the hospital sooner (p<0.0001). Likewise, those who had a detectable PCT at the time of admission were more likely to be readmitted sooner (p=0.03). PCT elevation during antibiotic treatment is associated with less improvement in FEV1 and earlier readmission. A detectable PCT level occurs only in more severe CF exacerbations. Multicenter trials are needed to confirm whether PCT may play a role in the clinical care of patients with CF.

scholarly journals Bronchodilator Responsiveness in Cystic Fibrosis Children Treated for Pulmonary Exacerbations

2021 ◽  
Author(s):  
Mordechai Pollak ◽  
Michelle Shaw ◽  
David Wilson ◽  
Melinda Solomon ◽  
Felix Ratjen ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Hospital Admissions ◽  
Forced Expiratory Volume ◽  
Clinical Value ◽  
Significant Drop ◽  
End Of Treatment ◽  
Repeated Events ◽  
Pulmonary Exacerbations ◽  
Response Testing

Background: Cystic fibrosis (CF) pulmonary exacerbations (PEx) are associated with significant drop in pulmonary function. The clinical value of measuring bronchodilator (BD) responsiveness during treatment for PEx to monitor or predict recovery of lung function is unclear. Methods: A retrospective analysis of spirometry with BD response testing obtained during hospital admissions for PEx in pediatric CF patients. Repeated events were included for patients with BD testing during multiple admissions. Results: 249 spirometries with BD testing in 102 patients were completed around day 7 (day 4-10) of hospital admission for treatment of CF PEx. Median (IQR) forced expiratory volume in one second (FEV1) was 70.6% predicted (58.1, 84.6) prior to the PEx event (best FEV1 in 6 months prior to admission), 54.4% (41.5, 66.9) at admission, 62.3% (48.4, 74.7) around day 7 of admission and 67.1% predicted (53.8, 78.2) at end of treatment. BD response around day 7 correlated poorly with FEV1 prior to PEx (r=-0.16, p=0.02), and did not correlate with recovery to baseline FEV1 at end of treatment (r=0.08, p=0.22). Only 23/249 (9%) patients had a BD response of ≥12 % and 200 ml. BD response was not related to age or severity of lung disease and led to an immediate change in clinical management in only 4 cases. CONCLUSIONS: BD response in CF patients treated for PEx is poorly correlated with baseline pulmonary function and does not correlate with recovery of FEV1 with treatment. These data suggest that routine testing for BD response is not indicated during PEx.

scholarly journals A first-year dornase alfa treatment impact on clinical parameters of patients with cystic fibrosis: the Brazilian cystic fibrosis multicenter study

2013 ◽  
Vol 31 (4) ◽  
pp. 420-430 ◽  
Author(s):  
Tatiana Rozov ◽  
Fernando Antônio A. e Silva ◽  
Maria Angélica Santana ◽  
Fabíola Villac Adde ◽  
Rita Heloisa Mendes
Keyword(s):  
Cystic Fibrosis ◽  
Emergency Room ◽  
Age Groups ◽  
Forced Expiratory Volume ◽  
First Year ◽  
Age Group ◽  
Emergency Room Visits ◽  
Dornase Alfa ◽  
Pulmonary Exacerbations ◽  
One Year

OBJECTIVE: To describe the clinical impact of the first year treatment with dornase alfa, according to age groups, in a cohort of Brazilian Cystic Fibrosis (CF) patients. METHODS: The data on 152 eligible patients, from 16 CF reference centers, that answered the medical questionnaires and performed laboratory tests at baseline (T0), and at six (T2) and 12 (T4) months after dornase alfa initiation, were analyzed. Three age groups were assessed: six to 11, 12 to 13, and >14 years. Pulmonary tests, airway microbiology, emergency room visits, hospitalizations, emergency and routine treatments were evaluated. Student's t-test, chi-square test and analysis of variance were used when appropriated. RESULTS: Routine treatments were based on respiratory physical therapy, regular exercises, pancreatic enzymes, vitamins, bronchodilators, corticosteroids, and antibiotics. In the six months prior the study (T0 phase), hospitalizations for pulmonary exacerbations occurred in 38.0, 10.0 and 61.4% in the three age groups, respectively. After one year of intervention, there was a significant reduction in the number of emergency room visits in the six to 11 years group. There were no significant changes in forced expiratory volume in one second (VEF1), in forced vital capacity (FVC), in oxygen saturation (SpO2), and in Tiffenau index for all age groups. A significant improvement in Shwachman-Kulczychi score was observed in the older group. In the last six months of therapy, chronic or intermittent colonization by P. aeruginosa was detected in 75.0, 71.4 and 62.5% of the studied groups, respectively, while S. aureus colonization was identified in 68.6, 66.6 and 41.9% of the cases. CONCLUSIONS: The treatment with dornase alfa promoted the maintenance of pulmonary function parameters and was associated with a significant reduction of emergency room visits due to pulmonary exacerbations in the six to 11 years age group, with better clinical scores in the >14 age group, one year after the intervention.

scholarly journals Home spirometry utilisation in telemedicine clinic for cystic fibrosis care during COVID-19 pandemic: a quality improvement process

2021 ◽  
Vol 10 (3) ◽  
pp. e001529
Author(s):  
Martina Compton ◽  
Rhonda List ◽  
Elissa Starheim ◽  
Lindsay Somerville ◽  
Lauren Williamson ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Quality Improvement ◽  
Chronic Care ◽  
Clinical Care ◽  
Forced Expiratory Volume ◽  
University Of Virginia ◽  
Care Model ◽  
Lung Function Decline ◽  
Quality Improvement Process ◽  
Care Guidelines

IntroductionThe Cystic Fibrosis (CF) Foundation chronic care guidelines recommend monitoring spirometry during quarterly multidisciplinary visits to identify early lung function decline. During the COVID-19 pandemic, the CF adult clinic at University of Virginia (UVA) transitioned from the classic CF care model to a model that included quarterly multidisciplinary telemedicine visits. While using telemedicine, CF care needed to include spirometry monitoring. Only a fraction of adult CF patients at UVA owned and used home spirometers (HS) in March 2020.AimThe specific aims of this quality improvement (QI) project were to increase the percentage of eligible adult CF patients who owned an HSs from 37% to 85% and to increase the percentage of adult CF patients seen at UVA with available spirometry in telemedicine from 50% to 95% by 31 December 2020.MethodsFollowing the Model for Improvement QI methodology, a standardised process was developed for monitoring forced expiratory volume in 1 s with HS during multidisciplinary telemedicine visits during the COVID-19 pandemic.Intervention(1) HSs were distributed to eligible patients and (2) Home spirometry was monitored in eligible patients with each telemedicine visit and results were used for clinical care decisions.ResultsBoth specific aims were achieved ahead of expected date. In March 2020, the beginning of the pandemic, 37% (49/131) of patients owned an HS and 50% (9/18) of patients seen via telemedicine performed spirometry at home. By September 2020, 97% (127/131) of adult patients at UVA owned an HS and by October 2020, 96% (24/25) of patients provided spirometry results during their telemedicine encounters.ConclusionEmploying QI tools to standardise the process of monitoring spirometry data with home devices via telemedicine is reliable and sustainable and can be replicated across centres that provide care for patients with CF.

scholarly journals Telephone surveillance during 2019 novel coronavirus disease: Is it a helpful diagnostic tool for detecting acute pulmonary exacerbations in children with chronic lung disease?

2020 ◽  
pp. 1357633X2097200
Author(s):  
Beste Ozsezen ◽  
Nagehan Emiralioglu ◽  
Dilber A Tural ◽  
Birce Sunman ◽  
Halime N Buyuksahin ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Transmission Risk ◽  
Nutrition Status ◽  
Peak Time ◽  
Pulmonary Exacerbation ◽  
Pulmonary Exacerbations ◽  
The Times ◽  
Novel Coronavirus

Introduction The global burden of the 2019 novel coronavirus disease pandemic on the healthcare system, as well as the high transmission risk of coronavirus disease has led to the use of alternative strategies for evaluation of children with chronic conditions. In this context, telemedicine has become the effective and affordable choice. In this study we aimed to evaluate the efficiency of telephone visits to determine pulmonary exacerbations and hospitalization rates of children with cystic fibrosis and interstitial lung disease. Methods A total of 119 children with cystic fibrosis or interstitial lung disease were enrolled and provided cases in which telephone visits were applied during the peak time of the coronavirus disease pandemic in our country. The recordings of respiratory, gastrointestinal and other symptoms, nutrition status, rate of acute pulmonary exacerbation, treatments initiated by telephone visits, referral to hospital and hospitalization were established from the electronic health reports of the patients. Results Thirteen patients (10.9%) were symptomatic, 12 of them (10%) were diagnosed with acute pulmonary exacerbation. One patient was diagnosed with peripheral facial paralysis. Nine patients were recalled to the hospital and seven patients (5.8%) were hospitalised. Discussion Using telemedicine the health status of patients can be defined, and patients can be guided on proper healthcare that they need, especially during the times of pandemics which we are facing. Communication with patients while minimising the risk of exposure to coronavirus disease is an important advantage of telemedicine. Telemedicine will have to be implemented on our daily medical practice in the near future.

scholarly journals Hyperpolarised 129Xe magnetic resonance imaging to monitor treatment response in children with cystic fibrosis

2019 ◽  
Vol 53 (5) ◽  
pp. 1802188 ◽  
Author(s):  
Jonathan H. Rayment ◽  
Marcus J. Couch ◽  
Nancy McDonald ◽  
Nikhil Kanhere ◽  
David Manson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cystic Fibrosis ◽  
Magnetic Resonance ◽  
Lung Disease ◽  
Treatment Response ◽  
Forced Expiratory Volume ◽  
Response To Therapy ◽  
Breath Hold ◽  
Pulmonary Exacerbation ◽  
Resonance Imaging

Pulmonary magnetic resonance imaging using hyperpolarised 129Xe gas (XeMRI) can quantify ventilation inhomogeneity by measuring the percentage of unventilated lung volume (ventilation defect per cent (VDP)). While previous studies have demonstrated its sensitivity for detecting early cystic fibrosis (CF) lung disease, the utility of XeMRI to monitor response to therapy in CF is unknown. The aim of this study was to assess the ability of XeMRI to capture treatment response in paediatric CF patients undergoing inpatient antibiotic treatment for a pulmonary exacerbation.15 CF patients aged 8–18 years underwent XeMRI, spirometry, plethysmography and multiple-breath nitrogen washout at the beginning and end of inpatient treatment of a pulmonary exacerbation. VDP was calculated from XeMRI images obtained during a static breath hold using semi-automated k-means clustering and linear binning approaches.XeMRI was well tolerated. VDP, lung clearance index and the forced expiratory volume in 1 s all improved with treatment; however, response was not uniform in individual patients. Of all outcome measures, VDP showed the largest relative improvement (−42.1%, 95% CI −52.1–−31.9%, p<0.0001).These data support further investigation of XeMRI as a tool to capture treatment response in CF lung disease.

scholarly journals Socioeconomic Status and the Likelihood of Antibiotic Treatment for Signs and Symptoms of Pulmonary Exacerbation in Children with Cystic Fibrosis

2011 ◽  
Vol 159 (5) ◽  
pp. 819-824.e1 ◽  
Author(s):  
Michael S. Schechter ◽  
Susanna A. McColley ◽  
Warren Regelmann ◽  
Stefanie J. Millar ◽  
David J. Pasta ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Socioeconomic Status ◽  
Antibiotic Treatment ◽  
Signs And Symptoms ◽  
Pulmonary Exacerbation

scholarly journals ANEMIA IN PREGNANT WOMEN;

2017 ◽  
Vol 24 (05) ◽  
pp. 675-679
Author(s):  
Tanvir Jahan ◽  
M. Ishaq - ◽  
Arif Siddiq
Keyword(s):  
Pregnant Women ◽  
Age Estimation ◽  
Descriptive Study ◽  
Included Study ◽  
Morbidity And Mortality ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Surrounding Areas ◽  
Time Of Admission ◽  
Prevalence Of Anemia

Objectives: To detect the prevalence of anemia in pregnant women in Multan inorder to decrease the maternal and fetal morbidity and mortality associated with this condition.Study designs: A retrospective descriptive study was conducted among pregnant womenattending Ibn-e-Siena Hospital. A total no. of 405 women were enrolled in this study. Studysetting: Study was conducted at Ibn-e-Siena Hospital Multan, Gynae department. It’s a teachinghospital draining Multan district and surrounding areas. Period: 1 year from May 2013 to June2014. Material Methods: All the pregnant ladies coming to Ibn-e-Siena Hospital in Obstetricsoutpatient department or through emergency and full filling the inclusion criteria were includedin this study. Hemoglobin %age estimation was performed at the time of admission and theladies were included in study as per inclusion and exclusion criteria. Results: A total no. of405 pregnant women were included study. Among them 71.35% were found to be anemic and28.65% were non anemic. Conclusion: Anemia is highly prevalent among pregnant ladies inMultan Region. Prompt measures should be taken at local and higher levels to prevent and treatthis problem in order to reduce its associated morbidity and mortality.

scholarly journals Acute Pulmonary Exacerbations in Cystic Fibrosis

2019 ◽  
Vol 40 (06) ◽  
pp. 792-803 ◽  
Author(s):  
Christopher H. Goss
Keyword(s):  
Cystic Fibrosis ◽  
Large Scale ◽  
Clinical Epidemiology ◽  
Transmembrane Conductance Regulator ◽  
Pulmonary Exacerbation ◽  
Multisystem Disease ◽  
Clinical Events ◽  
Treatment Paradigm ◽  
Pulmonary Exacerbations ◽  
Epidemiology Studies

AbstractWith the improving survival of cystic fibrosis (CF) patients and the advent of highly effective cystic fibrosis transmembrane conductance regulator therapy, the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is an acute pulmonary exacerbation. Clinical and microbial epidemiology studies of CF pulmonary exacerbations continue to provide important insight into the disease course, prognosis, and complications. This work has now led to a number of large scale clinical trials with the goal of improving the treatment paradigm for CF pulmonary exacerbation. The primary goal of this review is to provide a summary of the pathophysiology, the clinical epidemiology, microbial epidemiology, outcome and the treatment of CF pulmonary exacerbation.

Complete versus Limited Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Cystic Fibrosis

2020 ◽  
Vol 162 (4) ◽  
pp. 572-580 ◽  
Author(s):  
Daniel J. Lee ◽  
Christopher M. K. L. Yao ◽  
Jenna Sykes ◽  
Leena Rizvi ◽  
Elizabeth Tullis ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Postoperative Period ◽  
Endoscopic Sinus Surgery ◽  
Hospital Admissions ◽  
Care Center ◽  
Sinus Surgery ◽  
Oral Antibiotic ◽  
Health Care Center ◽  
Pulmonary Exacerbations

Objective To examine the effects of the extent of endoscopic sinus surgery (ESS) on pulmonary health, including the pulmonary exacerbations and lung function in patients with cystic fibrosis (CF). Study Design Retrospective cohort study. Setting Tertiary health care center. Subjects and Methods A retrospective review of patients with CF who underwent ESS at St. Michael’s Hospital between 1999 and 2016 was performed. Two groups of patients were identified based on the surgical extent: (1) complete (maxillary antrostomy, complete ethmoidectomy, sphenoidotomy, and frontal sinusotomy) and (2) limited (any ESS that involved less than complete). Primary outcomes included the number of pulmonary exacerbations (the use of oral or intravenous [IV] antibiotics), number of hospital admissions and hospital days during a 2-year pre- and postoperative period, and pulmonary function outcomes during a 1-year pre- and postoperative period. Results There were 70 procedures (30 complete and 40 limited) among 57 patients. Baseline characteristics were similar between the groups. Complete ESS group had a significant reduction in the oral antibiotic use compared to the limited ESS group (median, –1.0 [interquartile range (IQR), –2 to 0] in complete vs 0 [IQR, –1 to 1] in limited, P = .028). There was no difference in the use of IV antibiotics, number and duration of admissions, or rate of lung function change between the 2 groups. Conclusion Complete ESS may reduce mild forms of pulmonary exacerbations as shown in the decreased use of oral antibiotics. Overall, ESS does not significantly modify pulmonary outcomes in patients with CF.

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