In:
Pediatric Pulmonology, Wiley, Vol. 55, No. 3 ( 2020-03), p. 828-834
Abstract:
In cystic fibrosis, observation of a lung function drop (as percent predicted forced expiratory volume in 1 s [FEV 1 ]; ppFEV 1 ) frequently precedes pulmonary exacerbation (PEx) diagnosis. Recovery of ppFEV 1 to a previous “baseline” is commonly used to assess antimicrobial treatment response. However, not all diagnosed PEx are associated with a ppFEV 1 drop, and it is unclear whether these are a different type of PEx from those associated with a ppFEV 1 drop. Methods We analyzed pre‐ and posttreatment ppFEV 1 for PEx recorded in the Epidemiologic Study of Cystic Fibrosis from 2003 through 2005. Baseline, pretreatment, and follow‐up ppFEV 1 were the best recorded within 12‐months pre‐PEx, the lowest recorded −30 to +3 days of treatment, and the best recorded during 6‐month follow‐up, respectively. Logistic regression models for return of ppFEV 1 to baseline during follow‐up were developed separately for PEx with ≥10%, 〈 10%, and no ppFEV 1 drop before treatment. Results Of 15 147 PEx, 10 166 (67.1%), 3479 (23.0%), and 1502 (9.9%) presented with a ≥10%, 〈 10%, or no ppFEV 1 drop at diagnosis, respectively. 19.5%, 35.2%, and 65.6% of PEx, respectively, had follow‐up ppFEV 1 equal to or exceeding baseline; overall 27.7% of all PEx treatments resulted in complete recovery of baseline ppFEV 1 . Significant predictors of ppFEV 1 recovery at follow‐up were younger patient age, absence of Aspergillus , lower baseline ppFEV 1 , fewer visits during the baseline, lower frequency of prior‐year PEx, shorter elapsed time from baseline measure to treatment, smaller relative ppFEV 1 drop before treatment, and non intravenous (ie, oral or inhaled antibiotic) treatment. PEx with ≥10%, 〈 10%, and no ppFEV 1 drop before treatment had only modest differences in covariate odds ratios associated with complete ppFEV 1 recovery. Conclusions Among the 10% of PEx presenting with no apparent ppFEV 1 drop, more than one‐third resulted in a decreased ppFEV 1 during follow‐up. Risk factors for this outcome were the same as those associated with lack of ppFEV 1 recovery among PEx with pretreatment ppFEV 1 drops. These results suggest that inherent FEV 1 variability, baseline and follow‐up sampling methodologies, ppFEV 1 regression to the mean, and underlying lung disease progression complicate this approach for assessing effects of PEx and treatment response.
Type of Medium:
Online Resource
ISSN:
8755-6863
,
1099-0496
Language:
English
Publisher:
Wiley
Publication Date:
2020
detail.hit.zdb_id:
1491904-7
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