scholarly journals Wildfire Smoke Exposure Is Associated With Severe Pulmonary Exacerbation in Adult Cystic Fibrosis Patients

2021 ◽  
Author(s):  
Lily Amanda Cook ◽  
Bethany Collins ◽  
Aaron Trimble
Keyword(s):  
Cystic Fibrosis ◽  
Environmental Protection Agency ◽  
Pediatric Population ◽  
Fine Particulate Matter ◽  
Smoke Exposure ◽  
Pulmonary Exacerbation ◽  
Wildfire Smoke ◽  
Cystic Fibrosis Foundation ◽  
Pulmonary Exacerbations ◽  
Using Data

Abstract PurposeBecause pulmonary exacerbations in cystic fibrosis cause a step-wise decline in FEV1 function and contribute significantly to disease progression, it is important to identify potential environmental triggers. Studies have been done on general air quality and its relationship to cystic fibrosis disease activity, but none have examined air pollution caused by wildfire smoke. Our study intends to better understand this relationship. MethodsA retrospective cohort study was conducted using data collected from people with cystic fibrosis (CF) between 2012 and 2019. Data on pulmonary exacerbations was extracted from the patient registry hosted and maintained by the Cystic Fibrosis Foundation. Exposures were determined using measurements of fine particulate matter (PM2.5) from the Environmental Protection Agency. A logistic regression model was created in order to identify both univariate and adjusted odds ratios and their associated confidence intervals.Results82.7% (n = 415) of individuals with CF experienced an exposure to wildfire smoke during the study period. The adjusted odds ratio for a pulmonary exacerbation within one month following an exposure to wildfire smoke was 1.50 (95% CI = 1.13 – 1.99, p = 0.006) for adults and 0.92 (95% CI = 0.69 – 1.23, p = 0.578) for children. ConclusionWildfire smoke exposure is associated with severe pulmonary exacerbation in adults but not in children. This suggests that wildfire smoke may be an environmental risk factor for exacerbation in adults with CF. Further study is needed to understand why and how wildfire smoke exposure affects adult with CF differently than the pediatric population.

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 How to measure the economic health cost of wildfires – A systematic review of the literature for northern America

2020 ◽  
Vol 29 (11) ◽  
pp. 961
Author(s):  
Ruth Dittrich ◽  
Stuart McCallum
Keyword(s):  
Environmental Protection Agency ◽  
Economic Cost ◽  
Smoke Exposure ◽  
Health Cost ◽  
Mortality And Morbidity ◽  
Wildfire Smoke ◽  
The North ◽  
The Us ◽  
Emergent Literature ◽  
Economic Health

There has been an increasing interest in the economic health cost from smoke exposure from wildfires in the past 20 years, particularly in the north-western USA that is reflected in an emergent literature. In this review, we provide an overview and discussion of studies since 2006 on the health impacts of wildfire smoke and of approaches for the estimation of the associated economic cost. We focus on the choice of key variables such as cost estimators for determining the economic impact of mortality and morbidity effects. In addition, we provide an in-depth discussion and guidance on the functioning, advantages and challenges of BenMAP-CE, freely available software of the US Environmental Protection Agency (EPA) that has been used in a growing number of studies to assess cost from wildfire smoke. We highlight what generates differences in outcomes between relevant studies and make suggestions for increasing the comparability between studies. All studies, however, demonstrate highly significant health cost from smoke exposure, in the millions or billions of US dollars, often driven by increases in mortality. The results indicate the need to take health cost into account for a comprehensive analysis of wildfire impacts.

scholarly journals Vancomycin Dosing and Monitoring in the Treatment of Cystic Fibrosis: Results of a National Practice Survey

2017 ◽  
Vol 22 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Rebecca S. Pettit ◽  
Stacy J. Peters ◽  
Erin J. McDade ◽  
Kaci Kreilein ◽  
Radha Patel ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Trough Concentration ◽  
Pediatric Population ◽  
Area Under The Curve ◽  
Monitoring Strategy ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Monitoring Strategies ◽  
Cystic Fibrosis Foundation ◽  
Initial Starting

OBJECTIVES Vancomycin is commonly used in patients with cystic fibrosis (CF) to treat acute pulmonary exacerbations, but few guidelines exist to help dose and monitor patients. The objective of this study was to assess vancomycin use and monitoring strategies at Cystic Fibrosis Foundation (CFF)–accredited centers in hopes of developing and implementing vancomycin dosing and monitoring standards. METHODS An anonymous national cross-sectional survey of pharmacists affiliated with CFF-accredited pediatric and/or adult centers was performed by using Surveymonkey.com. The survey consisted of 3 sections: (1) CF Center Demographic Information (10 questions); 2) vancomycin use in pediatric CF patients (31 questions); and 3) vancomycin use in adult CF patients (29 questions); it was administered from March 9, 2015, to April 13, 2015. RESULTS The survey was completed by 31/69 (45%) pharmacists and 28 (90.3%) reported using vancomycin in the pediatric population. The most common initial starting dose for pediatric patients was 15 mg/kg/dose (57.1%) and every 6 hours was the most common dosing frequency (67.9%). The most common monitoring strategy was collection of a trough concentration (92.9%) with 57.7% of pharmacist targeting a range of 15 to 20 mg/L. The most common initial starting vancomycin dose in adults with CF was 15 mg/kg/dose (61.5%), and initial frequency of every 8 hours (73.1%). The most common monitoring strategy was a trough concentration (96.2%) with 83.3% of pharmacists reporting a goal trough range of 15 to 20 mg/L. CONCLUSIONS The most common vancomycin dosing reported was 15 to 20 mg/kg/dose every 6 hours (pediatric) and 15 to 20 mg/kg/dose every 8 to 12 hours (adults). Serum concentrations measured to meet monitoring parameters of trough concentrations of 15 to 20 mg/L, or area under the curve to minimum inhibitory concentration ratio > 400, were the same in both pediatric and adult patients.

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 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.

scholarly journals Risk factors for lung disease progression in children with cystic fibrosis

2018 ◽  
Vol 51 (6) ◽  
pp. 1702509 ◽  
Author(s):  
Marieke van Horck ◽  
Kim van de Kant ◽  
Bjorn Winkens ◽  
Geertjan Wesseling ◽  
Vincent Gulmans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Lung Disease ◽  
Disease Progression ◽  
Potential Risk ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Pulmonary Exacerbation ◽  
Exacerbation Rate ◽  
Potential Risk Factors ◽  
Pulmonary Exacerbations

To identify potential risk factors for lung disease progression in children with cystic fibrosis (CF), we studied the longitudinal data of all children with CF (aged ≥5 years) registered in the Dutch CF Registry (2009–2014).Lung disease progression was expressed as a decline in lung function (forced expiratory volume in 1 s (FEV1) % pred) and pulmonary exacerbation rate. Potential risk factors at baseline included sex, age, best FEV1 % pred, best forced vital capacity % pred, genotype, body mass index z-score, pancreatic insufficiency, medication use (proton pump inhibitors (PPIs), prophylactic antibiotics and inhaled corticosteroids), CF-related diabetes, allergic bronchopulmonary aspergillosis and colonisation with Pseudomonas aeruginosa.The data of 545 children were analysed. PPI use was associated with both annual decline of FEV1 % pred (p=0.017) and future pulmonary exacerbation rate (p=0.006). Moreover, lower FEV1 % pred at baseline (p=0.007), prophylactic inhaled antibiotic use (p=0.006) and pulmonary exacerbations in the baseline year (p=0.002) were related to pulmonary exacerbations in subsequent years.In a cohort of Dutch children with CF followed for 5 years, we were able to identify several risk factors for future exacerbations. In particular, the association between PPI use and lung disease progression definitely requires further investigation.

scholarly journals Recent advances in the understanding and management of cystic fibrosis pulmonary exacerbations

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 575 ◽  
Author(s):  
Kate Skolnik ◽  
Bradley S. Quon
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Significant Proportion ◽  
Pulmonary Exacerbation ◽  
Aggressive Treatment ◽  
Profound Impact ◽  
Recent Advances ◽  
Intravenous Antibiotics ◽  
Pulmonary Exacerbations

Pulmonary exacerbations are common events in cystic fibrosis and have a profound impact on quality of life, morbidity, and mortality. Pulmonary exacerbation outcomes remain poor and a significant proportion of patients fail to recover their baseline lung function despite receiving aggressive treatment with intravenous antibiotics. This focused review provides an update on some of the recent advances that have taken place in our understanding of the epidemiology, pathophysiology, diagnosis, and management of pulmonary exacerbations in cystic fibrosis as well as direction for future study.

scholarly journals Changes in airway inflammation during pulmonary exacerbations in patients with cystic fibrosis and primary ciliary dyskinesia

2015 ◽  
Vol 47 (3) ◽  
pp. 829-836 ◽  
Author(s):  
Felix Ratjen ◽  
Valerie Waters ◽  
Michelle Klingel ◽  
Nancy McDonald ◽  
Sharon Dell ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Inflammatory Response ◽  
Neutrophil Elastase ◽  
Primary Ciliary Dyskinesia ◽  
Bacterial Pathogens ◽  
Pulmonary Exacerbation ◽  
Elastase Activity ◽  
Cell Counts ◽  
Pulmonary Exacerbations ◽  
Ciliary Dyskinesia

Lung disease in patients with both primary ciliary dyskinesia (PCD) or cystic fibrosis (CF) is associated with impaired mucociliary clearance; however, clinical outcomes are typically worse in CF patients. We assessed whether CF and PCD patients differ in inflammatory response in the airways during pulmonary exacerbation.We first studied clinically stable PCD patients with a spectrum of bacterial pathogens to assess inflammatory response to different pathogens. Subsequently, PCD and CF patients with similar bacterial pathogens were studied at the time of a pulmonary exacerbation and after 21 days of antibiotics treatment. Qualitative and quantitative microbiology, cell counts, interleukin-8 concentrations, and neutrophil elastase activity were assessed in sputum samples obtained before and after treatment.In stable PCD patients, no significant differences were found in sputum inflammatory markers between individuals colonised with different bacterial pathogens. Pulmonary exacerbation severity assessed by a pulmonary exacerbation score and lung function decline from their previous baseline did not differ between CF and PCD patients. Bacterial density for Staphylococcus aureus and Haemophilus influenzae was higher in CF versus PCD (p<0.05), but absolute neutrophil counts were higher in PCD patients (p=0.02). While sputum elastase activity was similar in PCD and CF at the time of exacerbation, it decreased with antibiotic therapy in PCD (p<0.05) but not CF patients.PCD patients differ from those with CF in their responses to treatment of pulmonary exacerbations, with higher neutrophil elastase activity persisting in the CF airways at the end of treatment.

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