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Jones AM. Patient registry data highlights international differences in survival in cystic fibrosis. Thorax 2023; 78:223-224. [PMID: 36400456 DOI: 10.1136/thorax-2022-219600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester Foundation NHS Trust, Manchester, UK .,Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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2
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Athanazio RA, Tanni SE, Ferreira J, Dalcin PDTR, Fuccio MBD, Esposito C, Canan MGM, Coelho LS, Firmida MDC, Almeida MBD, Marostica PJC, Monte LDFV, Souza EL, Pinto LA, Rached SZ, Oliveira VSBD, Riedi CA, Silva Filho LVRFD. Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association). J Bras Pneumol 2023; 49:e20230040. [PMID: 37194817 DOI: 10.36416/1806-3756/e20230040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 05/18/2023] Open
Abstract
Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.
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Affiliation(s)
- Rodrigo Abensur Athanazio
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Suzana Erico Tanni
- . Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Julio de Mesquita Filho - UNESP - Botucatu (SP) Brasil
| | - Juliana Ferreira
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paulo de Tarso Roth Dalcin
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Marcelo B de Fuccio
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
| | | | | | - Liana Sousa Coelho
- . Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Julio de Mesquita Filho - UNESP - Botucatu (SP) Brasil
| | | | - Marina Buarque de Almeida
- . Unidade de Pneumologia, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Paulo José Cauduro Marostica
- . Unidade de Pneumologia Infantil, Hospital de Clínicas de Porto Alegre - HCPA - Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | - Edna Lúcia Souza
- . Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
| | | | - Samia Zahi Rached
- . Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Verônica Stasiak Bednarczuk de Oliveira
- . Hospital de Clínicas, Universidade Federal do Paraná, Curitiba (PR) Brasil
- . Unidos Pela Vida - Instituto Brasileiro de Atenção à Fibrose Cística, Curitiba (PR) Brasil
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3
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Escaldelai FMD, Silva Filho LVRFD, Neri LDCL, Bergamaschi DP. Quality of anthropometric data measured in children and adolescents with cystic fibrosis: a scoping review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021333. [PMID: 36888749 PMCID: PMC9984155 DOI: 10.1590/1984-0462/2023/41/2021333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/06/2022] [Indexed: 03/08/2023]
Abstract
OBJECTIVE This study aimed to identify methodological aspects involved in determining anthropometric measurements among studies assessing the nutritional status of individuals with cystic fibrosis (CF). METHODS A search of the literature was performed on MEDLINE via Pubmed, Embase, and Web of Science databases. The population comprised children and adolescents with CF. Observational studies and clinical trials using anthropometric and body composition measures and indices determined by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance assessment (BIA) were included. Use of a standardized procedure for data collection was defined when details on the instruments and their calibration were given, the measuring procedures were described, and when it was clear measures had been determined by a trained team, or the use of an anthropometric reference manual was cited. Data extracted were expressed as absolute and relative frequencies. RESULTS A total of 32 articles were included, and a total of 233 measures or indices were observed. The most frequently used measures were body mass index (kg/m2; 35%), weight (kg; 33%), and height (cm; 33%). Among the 28 studies that used anthropometric measures, 21 (75%) provided a complete or partial description of the measurement instruments used, 3 (11%) reported information on equipment calibration, 10 (36%) indicated the measurement procedures employed by assessors, and 2 (7%) stated a trained team had carried out the measurements. CONCLUSIONS The poor description of measuring procedures precluded a meaningful evaluation of data quality. Scientific debate on this theme can help raise awareness of the need to ensure quality in collecting and fully presenting data.
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Gifford AH, Taylor-Cousar JL, Davies JC, McNally P. Update on Clinical Outcomes of Highly Effective Modulator Therapy. Clin Chest Med 2022; 43:677-695. [PMID: 36344074 DOI: 10.1016/j.ccm.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Based on the cystic fibrosis transmembrane conductance regulator (CFTR) genotype, approximately 90% of people with cystic fibrosis (CF) are candidates for highly effective modulator therapy (HEMT). Clinical trials conducted over the last 11 years have shown that these oral therapies substantially restore CFTR function, leading to improvements in lung function, nutritional status, and health-related quality of life. Here, we review safety and efficacy data from phase 3 clinical trials and observational studies which support the use of HEMT in most adults and children with CF. We also discuss opportunities for additional investigation in groups underrepresented or excluded from phase 3 clinical trials, and challenges in the evaluation of the safety and efficacy of HEMT at increasingly earlier stages of CFTR-mediated pathophysiology.
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Affiliation(s)
- Alex H Gifford
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Bolwell Building 6174, Cleveland, OH 44106, USA; Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Jennifer L Taylor-Cousar
- Department of Internal Medicine, National Jewish Medical Center, Denver, CO, USA; Department of Pediatrics, National Jewish Medical Center, Denver, CO, USA
| | - Jane C Davies
- National Heart and Lung Institute, Imperial College London, England, United Kingdom; Royal Brompton & Harefield Hospital, Guys & St Thomas' Trust, London, United Kingdom
| | - Paul McNally
- Department of Paediatrics, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Cystic Fibrosis Center, Children's Health Ireland, Dublin, Ireland
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5
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Khush KK, Hsich E, Potena L, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Perch M, Sadavarte A, Toll A, Singh TP, Zuckermann A, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult heart transplantation report - 2021; Focus on recipient characteristics. J Heart Lung Transplant 2021; 40:1035-1049. [PMID: 34419370 DOI: 10.1016/j.healun.2021.07.015] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Kiran K Khush
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Eileen Hsich
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Daniel C Chambers
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Michael O Harhay
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Don Hayes
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Michael Perch
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Aparna Sadavarte
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Alice Toll
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Tajinder P Singh
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas.
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- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Dallas, Texas
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6
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Perrem LM, McNally P, Ratjen F. Apples to apples? Comparative analyses of national CF registries. Thorax 2021; 77:112-113. [PMID: 34413164 DOI: 10.1136/thoraxjnl-2021-217532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Lucy Mary Perrem
- Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul McNally
- CF Research Group, National Children's Research Centre, Dublin, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Felix Ratjen
- Department of Pediatrics; Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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7
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Gecili E, Brokamp C, Palipana A, Huang R, Andrinopoulou ER, Pestian T, Rasnick E, Keogh RH, Ni Y, Clancy JP, Ryan P, Szczesniak RD. Seasonal variation of lung function in cystic fibrosis: longitudinal modeling to compare a Midwest US cohort to international populations. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 776:145905. [PMID: 35125553 PMCID: PMC8813005 DOI: 10.1016/j.scitotenv.2021.145905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Characterizing seasonal trend in lung function in individuals with chronic lung disease may lead to timelier treatment of acute respiratory symptoms and more precise distinction between seasonal exposures and variability. Limited research has been conducted to assess localized seasonal fluctuation in lung function decline in individuals with cystic fibrosis (CF) in context with routinely collected demographic and clinical data. We conducted a longitudinal cohort study of 253 individuals aged 6-22 years with CF receiving care at a pediatric Midwestern US CF center with median (range) of follow-up time of 4.7 (0-9.95) years, implementing two distinct models to estimate seasonality effects. The outcome, lung function, was measured as percent-predicted of forced expiratory volume in 1 second (FEV1). Both models showed that older age, being male, using Medicaid insurance and having Pseudomonas aeruginosa infection corresponded to accelerated FEV1 decline. A sine wave model for seasonality had better fit to the data, compared to a linear model with categories for seasonality. Compared to international cohorts, seasonal fluctuations occurred earlier and with greater volatility, even after adjustment for ambient temperature. Average lung function peaked in February and dipped in August, and FEV1 fluctuation was 0.81 % predicted (95% CI: 0.52 to 1.1). Adjusting for temperature shifted the peak and dip to March and September, respectively, and decreased FEV1 fluctuation to 0.45 % predicted (95% CI: 0.08 to 0.82). Understanding localized seasonal variation and its impact on lung function may allow researchers to perform precision public health for lung diseases and disorders at the point-of-care level.
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Affiliation(s)
- Emrah Gecili
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Cole Brokamp
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Anushka Palipana
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Division of Statistics and Data Science, Department of Mathematics, University of Cincinnati, 155B McMicken Hall, Cincinnati, OH, USA
| | - Rui Huang
- Division of Statistics and Data Science, Department of Mathematics, University of Cincinnati, 155B McMicken Hall, Cincinnati, OH, USA
| | | | - Teresa Pestian
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Erika Rasnick
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Ruth H. Keogh
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Yizhao Ni
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - John P. Clancy
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
- Cystic Fibrosis Foundation, 4550 Montgomery Ave, Bethesda, MD, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Patrick Ryan
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Rhonda D. Szczesniak
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
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8
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Schlüter DK, Ostrenga JS, Carr SB, Fink AK, Faro A, Szczesniak RD, Keogh RH, Charman SC, Marshall BC, Goss CH, Taylor-Robinson D. Lung function in children with cystic fibrosis in the USA and UK: a comparative longitudinal analysis of national registry data. Thorax 2021; 77:136-142. [PMID: 33975926 PMCID: PMC8581063 DOI: 10.1136/thoraxjnl-2021-216849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022]
Abstract
Rationale A previous analysis found significantly higher lung function in the US paediatric cystic fibrosis (CF) population compared with the UK with this difference apparently decreasing in adolescence and adulthood. However, the cross-sectional nature of the study makes it hard to interpret these results. Objectives To compare longitudinal trajectories of lung function in children with CF between the USA and UK and to explore reasons for any differences. Methods We used mixed effects regression analysis to model lung function trajectories in the study populations. Using descriptive statistics, we compared early growth and nutrition (height, weight, body mass index), infections (Pseudomonas aeruginosa, Staphylococcus aureus) and treatments (rhDnase, hypertonic saline, inhaled antibiotics). Results We included 9463 children from the USA and 3055 children from the UK with homozygous F508del genotype. Lung function was higher in the USA than in the UK when first measured at age six and remained higher throughout childhood. We did not find important differences in early growth and nutrition, or P.aeruginosa infection. Prescription of rhDNase and hypertonic saline was more common in the USA. Inhaled antibiotics were prescribed at similar levels in both countries, but Tobramycin was prescribed more in the USA and colistin in the UK. S. aureus infection was more common in the USA than the UK. Conclusions Children with CF and homozygous F508del genotype in the USA had better lung function than UK children. These differences do not appear to be explained by early growth or nutrition, but differences in the use of early treatments need further investigation.
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Affiliation(s)
- Daniela K Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Siobhán B Carr
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Aliza K Fink
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Rhonda D Szczesniak
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Christopher H Goss
- Departments of Medicine and Pediatrics, University of Washington, Seattle, Washington, USA
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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9
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Hoo ZH, Hitchcock L, Curley R, Wildman MJ. A comparison of the CFHH criteria against the Leeds criteria in determining the Pseudomonas aeruginosa status among adults with cystic fibrosis. Respir Med 2020; 171:106103. [PMID: 32758991 DOI: 10.1016/j.rmed.2020.106103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) status influences management decisions in cystic fibrosis (CF) but diagnostic approaches vary. We evaluated the ability of the CFHealthHub (CFHH) criteria, which consist of two major and four minor statements, in diagnosing chronic PA infection among adults with CF. METHODS In this retrospective cross-sectional analysis, we compared the CFHH criteria against the Leeds criteria. Data were collected between 1st January and 31st December 2016 from all adults with CF receiving care at Sheffield, excluding those with lung transplantation (n = 7) or on ivacaftor (n = 13). The CFHH criteria PA status were cross-tabulated against the Leeds criteria, and clinical outcomes between chronic PA vs non chronic PA for both criteria were compared. RESULTS This analysis included 186 adults with CF (90 females, median age 27 years, median baseline FEV1 78.5%). The CFHH criteria diagnosed more cases of chronic PA (116/186, 62.4% vs 79/186, 42.5%), and 37/107 cases of non-chronic PA according to the Leeds criteria were deemed chronic PA by the CFHH criteria. The magnitude of difference in %FEV1 decline between chronic PA vs non chronic PA was slightly greater for the CFHH criteria (-0.6%, 95% CI -1.8 to 0.6%) compared to the Leeds criteria (-0.2%, 95% CI -1.3 to 1.0%). CONCLUSIONS The CFHH criteria detected more chronic PA cases yet still retained similar levels of discrimination for health outcomes in comparison to the Leeds criteria. These findings provide preliminary evidence for the validity of the CFHH criteria among adults with CF.
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Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK.
| | - Lydia Hitchcock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Rachael Curley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
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10
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Er B, Çelebioğlu E, Yalçin E, Doğru D, Erden Aki Ö, Uzun Ö, Akova M, Özçelik U, Kiper N, Emri S. Factors associated with severe lung disease in an adult population with cystic fibrosis: a single-center experience. Turk J Med Sci 2020; 50:945-952. [PMID: 32394679 PMCID: PMC7379455 DOI: 10.3906/sag-1912-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/05/2020] [Indexed: 11/03/2022] Open
Abstract
Background/Aim The patients with cystic fibrosis (CF) are living longer compared to the past, but respiratory failure is still the most common cause of mortality. The aim of this study is to investigate factors associated with severe lung disease in a cohort of adult patients with CF. Materials and methods Demographic data, clinical and laboratory findings of the patients aged 18 years and more were collected and the patients were grouped according to forced expiratory volume in 1 s (FEV1) as severe group: <40% and nonsevere ≥40%. Associations were investigated between groups and clinical outcomes. Results A total of 76 patients were enrolled in the study. The mean age was 24.5 ± 5.25 years and 36 (47.4%) patients were female. In the severe group; the mean age was higher (27.1 ± 6.0 vs 23.6 ± 4.7, P = 0.013), the median Chrispin-Norman score of severe lung disease group was higher (14 (6–22) vs 5.5 (0–20), P < 0.001), hospitalization at least once in a year for intravenous antibiotic was more common (12/18 (66%) vs 19/58 (32%), P = 0.014). There was a positive correlation between body mass index (BMI) and lung function, indicating that lower nutritional status was related to lower FEV1, r2 = 0.21, P < 0.001. The median FEV1% was lower in patients with CF-related diabetes (38 (14–95) vs 66 (13–121), P = 0.042). Dornase alpha use and physiotherapy rate were higher in severe lung disease group (P = 0.008 and P < 0.001, respectively). Conclusion Lower BMI, older age, presence of CF-related diabetes, higher radiologic scores, use of dornase alpha and physiotherapy and higher hospitalization rate for intravenous antibiotic therapy are significantly associated with severe lung disease.
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Affiliation(s)
- Berrin Er
- Medical Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Çelebioğlu
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalçin
- Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Doğru
- Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özlem Erden Aki
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Uğur Özçelik
- Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Salih Emri
- Department of Chest Diseases, Medicana Kadıköy, İstanbul, Turkey
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11
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Cunningham S. Microbiological outliers in cystic fibrosis: resolving uncertainty. THE LANCET RESPIRATORY MEDICINE 2019; 7:995-997. [PMID: 31727594 DOI: 10.1016/s2213-2600(19)30405-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Steve Cunningham
- Professor of Paediatric Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh, Edinburgh, EH9 1LF, UK.
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12
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MacNeill SJ, Pierotti L, Mohammed MA, Wildman M, Boote J, Harrison S, Carr SB, Cullinan P, Elston C, Bilton D. Identifying exceptional cystic fibrosis care services: combining statistical process control with focus groups. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The Cystic Fibrosis (CF) Registry collects clinical data on all patients attending specialist CF centres in the UK. These data have been used to make comparisons between centres on key outcomes such as forced expiratory volume in 1 second (FEV1) using simple rankings, which promote the assumption that those with the highest measures provide ‘better’ care.
Objectives
To explore whether or not using statistical ‘process control’ charts that move away from league tables and adjusting for case mix (age, where appropriate; sex; CF genotype; pancreatic sufficiency; and socioeconomic status) could identify exceptional CF care services in terms of clinically meaningful outcomes. Then, using insight from patients and clinicians on what structures, processes and policies are necessary for delivering good CF care, to explore whether or not care is associated with observed differences in outcomes.
Design
Cross-sectional analyses.
Setting
Specialist CF centres in the UK.
Participants
Patients aged ≥ 6 years attending specialist CF centres and clinicians at these centres.
Main outcome measures
FEV1% predicted.
Data sources
Annual reviews taken from the UK CF Registry (2007–15).
Results
We studied FEV1 in many different ways and in different periods. In our analyses of both adult and paediatric centres, we observed that some centres showed repeated evidence of ‘special-cause variation’, with mean FEV1 being greater than the mean in some cases and lower than the mean in others. Some of these differences were explained by statistical adjustment for different measures of case mix, such as age, socioeconomic status, genotype and pancreatic sufficiency. After adjustment, there was some remaining evidence of special-cause variation for some centres. Our data at these centres suggest that there may be an association with the use of intravenous antibiotics. Workshops and focus groups with clinicians at paediatric and adult centres identified a number of structures, processes and policies that were felt to be associated with good care. From these, questionnaires for CF centre directors were developed and disseminated. However, the response rate was low, limiting the questionnaires’ use. Focus groups with patients to gain their insights into what is necessary for the delivery of good care identified themes similar to those identified by clinicians, and a patient questionnaire was developed based on these insights.
Limitations
Our data analyses suggest that differences in intravenous antibiotic usage may be associated with centre-level outcomes; this needs to be explored further in partnership with the centres. Our survey of centre directors yielded a low response, making it difficult to gain useful knowledge to inform further discussions with sites.
Conclusions
Our findings confirm that the CF Registry can be used to identify differences in clinical outcomes between centres and that case mix might explain some of these differences. As such, adjustment for case mix is essential when trying to understand how and why centres differ from the mean.
Future work
Future work will involve exploring with clinicians how care is delivered so that we can understand associations between care and outcomes. Patients will also be asked for their perspectives on the care they receive.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephanie J MacNeill
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Livia Pierotti
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Martin Wildman
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan Boote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steve Harrison
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Siobhán B Carr
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Paul Cullinan
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Diana Bilton
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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13
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Taylor-Robinson D, Archangelidi O, Carr SB, Cosgriff R, Gunn E, Keogh RH, MacDougall A, Newsome S, Schlüter DK, Stanojevic S, Bilton D. Data Resource Profile: The UK Cystic Fibrosis Registry. Int J Epidemiol 2019; 47:9-10e. [PMID: 29040601 PMCID: PMC5837577 DOI: 10.1093/ije/dyx196] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Olia Archangelidi
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Siobhán B Carr
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London
| | | | | | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Amy MacDougall
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Simon Newsome
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniela K Schlüter
- Centre for Health Informatics, Computing and Statistics (CHICAS), Lancaster University, Lancaster, UK
| | - Sanja Stanojevic
- Translational Medicine, Hospital for Sick Children and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Diana Bilton
- National Heart and Lung Institute, Imperial College London, London, UK
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14
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Grosse SD, Do TQN, Vu M, Feng LB, Berry JG, Sawicki GS. Healthcare expenditures for privately insured US patients with cystic fibrosis, 2010-2016. Pediatr Pulmonol 2018; 53:1611-1618. [PMID: 30381911 PMCID: PMC6688469 DOI: 10.1002/ppul.24178] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/05/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Published cost estimates for cystic fibrosis (CF) are based on older data and do not reflect increased use of specialty drugs in recent years. We assessed recent trends in healthcare expenditures for CF patients in the United States (US) with employer-sponsored health insurance. METHODS The study is a retrospective analysis of claims data for privately insured individuals aged 0-64 years who were continuously enrolled in non-capitated plans for at least 1 calendar year during 2010-2016. Mean annual expenditures during a calendar year were calculated for individuals who met a claims-based CF case definition. Average annual growth rates were calculated through linear regression of the natural logarithm of annual expenditures. RESULTS The annual CF prevalence was 1.1-1.4 per 10 000 adults and 2.9-3.0 per 10 000 children. Average spending adjusted for inflation nearly doubled from roughly $67 000 per patient in 2010 and 2011 to approximately $131 000 per patient in 2016. Inflation-adjusted spending on outpatient and inpatient care increased by 0.5% and 2.5% per year, respectively, whereas pharmaceutical spending increased by 20.2% per year. Virtually all of the growth in pharmaceutical spending was accounted for by spending on specialty drugs; inflation-adjusted spending on other medications increased by 1.3% per year. The annual growth rate in pharmaceutical spending rose by 33.1% during 2014-2016, the years during which lumacaftor/ivacaftor was introduced. CONCLUSIONS Per-patient expenditures for privately-insured patients with CF almost doubled during 2010-2016; specialty drugs were largely responsible for this increase, with a major contribution from new, genotype-targeted CFTR modulator medications.
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Affiliation(s)
- Scott D. Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Thuy Quynh N. Do
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Michelle Vu
- Mercer University College of Pharmacy and College of Health Professions, Atlanta, Georgia
| | | | - Jay G. Berry
- Complex Care Service, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Gregory S. Sawicki
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, Massachusetts
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15
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McIntyre K, Bertrand DP, Rault G. Using registry data to improve quality of care. J Cyst Fibros 2018; 17:566-572. [DOI: 10.1016/j.jcf.2018.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/09/2018] [Accepted: 06/09/2018] [Indexed: 11/17/2022]
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16
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Halbeisen FS, Goutaki M, Spycher BD, Amirav I, Behan L, Boon M, Hogg C, Casaulta C, Crowley S, Haarman EG, Karadag B, Koerner-Rettberg C, Loebinger MR, Mazurek H, Morgan L, Nielsen KG, Omran H, Santamaria F, Schwerk N, Thouvenin G, Yiallouros P, Lucas JS, Latzin P, Kuehni CE. Lung function in patients with primary ciliary dyskinesia: an iPCD Cohort study. Eur Respir J 2018; 52:13993003.01040-2018. [PMID: 30049738 DOI: 10.1183/13993003.01040-2018] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023]
Abstract
Primary ciliary dyskinesia (PCD) has been considered a relatively mild disease, especially compared to cystic fibrosis (CF), but studies on lung function in PCD patients have been few and small.This study compared lung function from spirometry of PCD patients to normal reference values and to published data from CF patients. We calculated z-scores and % predicted values for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) using the Global Lung Function Initiative 2012 values for 991 patients from the international PCD Cohort. We then assessed associations with age, sex, country, diagnostic certainty, organ laterality, body mass index and age at diagnosis in linear regression models. Lung function in PCD patients was reduced compared to reference values in both sexes and all age groups. Children aged 6-9 years had the smallest impairment (FEV1 z-score -0.84 (-1.03 to -0.65), FVC z-score -0.31 (-0.51 to -0.11)). Compared to CF patients, FEV1 was similarly reduced in children (age 6-9 years PCD 91% (88-93%); CF 90% (88-91%)), but less impaired in young adults (age 18-21 years PCD 79% (76-82%); CF 66% (65-68%)). The results suggest that PCD affects lung function from early in life, which emphasises the importance of early standardised care for all patients.
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Affiliation(s)
- Florian S Halbeisen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Israel Amirav
- The PCD Israeli Consortium.,Dept of Pediatrics, Faculty of Medicine, Bar IIan University, Ramat Gan, Israel.,Dept of Pediatrics, University of Medicine, Edmonton, AB, Canada
| | - Laura Behan
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK.,School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mieke Boon
- Dept of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Claire Hogg
- Dept of Paediatrics, Primary Ciliary Dyskinesia Centre, Royal Brompton and Harefield Foundation Trust, London, UK
| | - Carmen Casaulta
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.,The Swiss PCD Group
| | - Suzanne Crowley
- Unit for Paediatric Heart, Lung, Allergic Diseases, Rikshospitalet, Oslo, Norway
| | - Eric G Haarman
- Dept of Pediatric Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bulent Karadag
- Dept of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Cordula Koerner-Rettberg
- Dept of Paediatric Pneumology, University Children's Hospital of Ruhr University Bochum, Bochum, Germany
| | - Michael R Loebinger
- Host Defence Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Henryk Mazurek
- Dept of Pneumonology and Cystic Fibrosis, Institute of Tuberculosis and Lung Disorders, Rabka-Zdrój, Poland
| | - Lucy Morgan
- Dept of Respiratory Medicine, Concord Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Kim G Nielsen
- Danish PCD Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heymut Omran
- Dept of General Paediatrics and Adolescent Medicine, University Hospital Muenster, Muenster, Germany
| | | | - Nicolaus Schwerk
- Clinic for Paediatric Pulmonology, Allergiology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Guillaume Thouvenin
- The French Reference Centre for Rare Lung Diseases.,Paediatric Pulmonary Dept, Trousseau Hospital APHP, Sorbonne Universities and Pierre et Marie Curie University, Paris, France.,INSERM U938-CRSA, Paris, France
| | | | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Philipp Latzin
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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17
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Abstract
There are several benefits to clinical registries as an information repository tool, ultimately lending itself to the acquisition of new knowledge. Registries have the unique advantage of garnering much data quickly and are, therefore, especially helpful for niche populations or low-prevalence diseases. They can be used to inform on the ideal structure, process, or outcome involving an identified population. The data can be used in many ways, for example, as an observational tool to reveal associations or as a basis for framing future research studies or quality improvement projects.
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18
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Pragmatic criteria to define chronic pseudomonas aeruginosa infection among adults with cystic fibrosis. Eur J Clin Microbiol Infect Dis 2018; 37:2219-2222. [PMID: 30121804 DOI: 10.1007/s10096-018-3358-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/03/2018] [Indexed: 01/09/2023]
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19
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Hoo ZH, Curley R, Campbell MJ, Walters SJ, Wildman MJ. The importance of data issues when comparing cystic fibrosis registry outcomes between countries: Are annual review FEV 1 in the UK only collected when subjects are well? J Eval Clin Pract 2018; 24:745-751. [PMID: 29901239 PMCID: PMC6099433 DOI: 10.1111/jep.12967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 01/08/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVE Cross-country comparisons of cystic fibrosis (CF) outcomes can potentially identify variation in care but are dependent on data quality. An important assumption is that the UK annual review FEV1 is only collected during periods of clinical stability. If this assumption does not hold, results of FEV1 comparisons may be biased in favour of registries with encounter-based FEV1 . We aimed to test the assumption that CF annual reviews in the UK are only performed during periods of clinical stability. METHOD Prospective encounter-based data collected in Sheffield (n = 174) was used to establish whether annual review FEV1 were always collected during periods of clinical stability and to determine the group-level discrepancy between annual review vs best FEV1 . We then went on to quantify the group-level discrepancy between annual review and best annual FEV1 readings within the UK registry (n = 2995) to determine if the differences observed in Sheffield also apply to the wider UK data. RESULTS Sheffield results showed a group-level discrepancy between best and annual review FEV1 of -2.5% (95% CI -3.95% to -1.2%) for annual reviews performed during periods of clinical stability (n = 50). The group-level discrepancy is larger at -8.0% (95% CI -11.2% to -4.9%) among annual reviews performed during periods of clinical instability (n = 13). Therefore, the magnitude of this group-level discrepancy is a surrogate for the proportion of clinically stable annual reviews-smaller discrepancy indicates a higher proportion of clinically stable annual reviews and vice versa. The overall group-level discrepancy in the UK registry (-5.6%, 95% CI -5.9 to -5.4%) was similar to Sheffield (-6.1%, 95% CI -7.1 to -5.1%). Around 20% of the clinician reviewed, annual reviews in Sheffield were performed during periods of clinically instability. CONCLUSIONS Annual review FEV1 underestimates lung health of adults with CF in the UK and may bias cross-country comparisons.
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Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Rachael Curley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Michael J Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
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20
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McCarthy C, Lara Gallego B, Trapnell BC, McCormack FX. Epidemiology of Rare Lung Diseases: The Challenges and Opportunities to Improve Research and Knowledge. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1031:419-442. [PMID: 29214586 DOI: 10.1007/978-3-319-67144-4_24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rare lung diseases encompass a broad spectrum of conditions and affect an estimated 1.2-2.5 million people in North America and 1.5-3 million people in Europe. While individual rare lung diseases affect less than 1 in 2000 individuals, collectively they have a significant impact upon the population at large. Hence it is vital to understand firstly the epidemiology and subsequently the pathogenesis and clinical course of these disorders. Through a greater understanding of these aspects of disease, progress can be made in reducing symptoms, containing healthcare costs and utilizing resources efficiently. Furthermore, a greater understanding of the pathobiology of rare lung diseases can inform both the pathogenesis and management of more common pulmonary disorders.In this chapter we review how epidemiological approaches and the utilization of patient registries has improved the knowledge and management of rare lung diseases. We further focus on the epidemiology of several of the more widely known rare pulmonary disorders, including idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF) and alpha-1 antitrypsin deficiency (AATD). To conclude we describe how patient advocacy groups and foundations have driven advances in research and management of ultra-rare lung diseases, namely, the major strides made in the management and understanding of lymphangioleiomyomatosis (LAM) and pulmonary alveolar proteinosis (PAP).We conclude that the models used to study some of the rarest of diseases may be successfully adopted by other rare and common disease communities, leading to improved care and the possibility of novel therapeutic options.
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Affiliation(s)
- Cormac McCarthy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, 45267-0564, USA. .,Translational Pulmonary Science Center Cincinnati Children's Hospital, 3333 Burnet Avenue, CCRF S4621, 45229-3039, Cincinnati, OH, USA. .,Rare Lung Diseases Clinical (RLDC), Cincinnati, OH, USA.
| | - Beatriz Lara Gallego
- Respiratory Medicine Department, Coventry University Hospital, Third Floor, East wing. Clifford Bridge Road, Coventry, CV2 2DX, Warwickshire, UK
| | - Bruce C Trapnell
- Translational Pulmonary Science Center Cincinnati Children's Hospital, 3333 Burnet Avenue, CCRF S4621, 45229-3039, Cincinnati, OH, USA.,Rare Lung Diseases Clinical (RLDC), Cincinnati, OH, USA.,Medicine and Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, CCRF R4029, 45229-3039, Cincinnati, OH, USA
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, 45267-0564, USA
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21
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Prevalence of severe fatigue among adults with cystic fibrosis: A single center study. J Cyst Fibros 2018; 17:368-374. [PMID: 29606526 DOI: 10.1016/j.jcf.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/13/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND With life expectancy increasing among patients with cystic fibrosis (CF), the prevalence of complications such as fatigue is also expected to increase. Our aim was to investigate the prevalence of severe fatigue among adults with CF and to identify factors associated with fatigue. METHODS Adult patients with CF receiving treatment at a single center were invited to complete three questionnaires. We then studied the associations between fatigue and clinically measured parameters and between fatigue and patient-reported outcomes. RESULTS A total of 77 patients (age 19-54years; 56% males; mean FEV1: 63%) completed the questionnaires (43% response rate). The prevalence of severe fatigue among these patients was 26%. The variance in fatigue was explained partially by clinically measured parameters. However, patient-reported outcomes were stronger independently associated with fatigue and included the patients' reported respiratory symptoms, emotional functioning, and social functioning. CONCLUSIONS Fatigue is a clinically important and highly prevalent issue among adults with CF and is associated with a significant reduction in health-related quality of life and participation in society. In addition, fatigue is associated more strongly with the patient's perception of symptoms and well-being than with clinically measured parameters.
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22
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Dasenbrook EC, Sawicki GS. Cystic fibrosis patient registries: A valuable source for clinical research. J Cyst Fibros 2018; 17:433-440. [PMID: 29555479 DOI: 10.1016/j.jcf.2018.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 02/08/2023]
Abstract
Cystic Fibrosis (CF) patient registries are valuable data sources for researchers studying the natural history, treatment paradigms, and long-term health outcomes of individuals with CF. In this review, we discuss the role of CF patient registries in facilitating comparative effectiveness research, particularly evaluating therapies and variation in health care delivery. We also discuss the limitations of registry-based research, particularly indication bias, as well as statistical methods that can be used to address these issues.
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Affiliation(s)
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, United States.
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23
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Goss CH, Sykes J, Stanojevic S, Marshall B, Petren K, Ostrenga J, Fink A, Elbert A, Quon BS, Stephenson AL. Comparison of Nutrition and Lung Function Outcomes in Patients with Cystic Fibrosis Living in Canada and the United States. Am J Respir Crit Care Med 2018; 197:768-775. [PMID: 29099606 PMCID: PMC5855073 DOI: 10.1164/rccm.201707-1541oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022] Open
Abstract
RATIONALE A 10-year gap in the median age of survival for patients with cystic fibrosis (CF) was reported between patients living in Canada compared with patients living in the United States. OBJECTIVES Because both malnutrition and poor lung function are associated with an increased risk of mortality in CF, we investigated the temporal and longitudinal trends in lung function and nutrition between Canada and the United States. METHODS This cohort study used Canadian CF Registry and U.S. CF Foundation Patient Registry data from 1990 to 2013. A unified dataset was created to harmonize the variables collected within the two registries for the purpose of comparing outcomes between the two countries. MEASUREMENTS AND MAIN RESULTS We conducted three analyses: survival differences by birth cohort; population trends for FEV1 and body mass index (BMI) over time; and individual patient FEV1 and BMI trajectories. The study included a total of 37,772 patients in the United States and 5,149 patients in Canada. Patients with CF experienced significant improvements in nutritional status and lung function in both Canada and the United States during the study. In addition, the survival gap between the two countries is narrowing within younger birth cohorts. The improvements for the patients within the United States were most prominent in the BMI trajectories, where patients born after 1990 in the United States have higher BMI that has persisted over time. CONCLUSIONS The reasons for the observed improvements, and catch-up in the United States, are likely multifactorial and include the introduction of high-fat, high-calorie diets; introduction of newborn screening; and/or improved access to care for CF children in the United States.
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Affiliation(s)
- Christopher H. Goss
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Pediatrics, University of Washington Medical Center, Seattle, Washington
| | - Jenna Sykes
- Department of Respirology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sanja Stanojevic
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Aliza Fink
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | | | - Bradley S. Quon
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne L. Stephenson
- Department of Respirology, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
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24
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Abstract
Comparative effectiveness research (CER) has become increasing central to clinical research in medicine. CER seeks to conduct clinical trials that compare different commonly used interventions in real-world settings (pragmatic clinical trials) and use a multitude of sources of evidence (including registries and cohort studies) to inform clinical decision making. CER also ensures that stakeholders (patients, families, care providers, insurers) have a voice in the research process by integrating formal stakeholder engagement as part of the research. This innovative approach to clinical research has distinct benefits and pitfalls. This review first defines what CER is and then describes some of its benefits and then pitfalls. The focus is on the role of CER in pediatrics.
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25
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The Cystic Fibrosis Foundation Patient Registry. Design and Methods of a National Observational Disease Registry. Ann Am Thorac Soc 2018; 13:1173-9. [PMID: 27078236 DOI: 10.1513/annalsats.201511-781oc] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The Cystic Fibrosis Foundation Patient Registry (CFFPR) is an ongoing patient registry study that collects longitudinal demographic, clinical, and treatment information about persons with cystic fibrosis (CF) in the United States. CF is a life-shortening genetic disorder that occurs in approximately 1 in 3,500 births in the United States. High-quality observational data is important for clinical research, quality improvement, and clinical management. OBJECTIVES To describe the data collection, patient population, and key limitations of the CFFPR. METHODS Inclusion criteria for the CFFPR include diagnosis with CF or a CFTR-associated disorder, care at an accredited care center program, and provision of informed consent. Data from clinic visits and hospitalizations are collected through a secure website. Loss to follow-up and generalizability were examined using several methods. The accuracy of CFFPR data was evaluated with an audit of 2012 CFFPR data compared to the medical record. MEASUREMENTS AND MAIN RESULTS Since 1986, the CFFPR contains the records of 48,463 individuals with CF. Participation among individuals seen at accredited care centers is high, and loss to follow-up is low. An audit of 2012 CFFPR data suggests that the CFFPR contains 95% of clinic visits and 90% of hospitalizations found in the medical record for these patients, and nearly all of the audited fields were highly accurate. CONCLUSIONS Registries such as the CFFPR are important tools for research, clinical care, and tracking incidence, mortality and population trends.
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26
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Fink AK, Loeffler DR, Marshall BC, Goss CH, Morgan WJ. Data that empower: The success and promise of CF patient registries. Pediatr Pulmonol 2017; 52:S44-S51. [PMID: 28910520 DOI: 10.1002/ppul.23790] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/30/2017] [Indexed: 12/17/2022]
Abstract
In this article, we describe existing CF registries with a focus on US registry data collected through the CF Foundation Patient Registry (CFFPR) and the Epidemiologic Study of CF (ESCF); highlight what registries have taught us regarding epidemiology of CF; showcase the impact of registries on research and clinical care; and discuss future directions. This manuscript complements the plenary address given by Dr Wayne Morgan at the 2016 North American CF Conference by summarizing the key points from the presentation and providing additional detail and information.
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Affiliation(s)
| | | | | | - Christopher H Goss
- Department of Medicine and Pediatrics, University of Washington, Seattle, Washington
| | - Wayne J Morgan
- Department of Pediatrics, University of Arizona, Tucson, Arizona
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27
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Hoo ZH, Wildman MJ, Curley R, Walters SJ, Campbell MJ. Rescue therapy within the UK Cystic Fibrosis Registry: An exploration of predictors of intravenous antibiotic use amongst adults with CF. Respirology 2017; 23:190-197. [PMID: 28905459 PMCID: PMC5813205 DOI: 10.1111/resp.13174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/06/2017] [Accepted: 07/17/2017] [Indexed: 01/09/2023]
Abstract
Background and objective Intravenous (i.v.) antibiotics are needed for rescue when preventative therapy fails to achieve stability among adults with cystic fibrosis (CF). Understanding the distribution of i.v. days can provide insight into the care that adults with CF need. We aim to determine the baseline characteristics that are associated with higher i.v. use, in particular to test the hypothesis that prior‐year i.v. use is associated with future‐year i.v. use. Methods This is a cross‐sectional analysis of the 2013–2014 UK CF registry data. Stepwise logistic regression was performed using current‐year i.v. days as the dependent variable, and demographic variables including prior‐year i.v. days as the covariates. Based on these results, study sample was divided into clinically meaningful subgroups using analysis similar to tree‐based method. Results Data were available for 4269 adults in 2013 and 4644 adults in 2014. Prior‐year i.v. use was the strongest predictor for current‐year i.v. use followed by forced expiratory volume in 1 s (FEV1). Adults with high prior‐year i.v. use (>14 days) continued to require high levels of i.v., regardless of FEV1. Those with high prior‐year i.v. use and FEV1 ≥70% had higher current‐year i.v. days compared to adults with low prior‐year i.v. use and FEV1 <40% (28 days, interquartile range (IQR): 11–41 days vs 14 days, IQR: 0–28 days; Mann–Whitney P‐value <0.001 in 2013). Conclusion CF people with prior high levels of rescue often continue to need high levels of rescue even if they have good FEV1. The reasons for this require further investigations. Intravenous (i.v.) antibiotic is an important treatment option in cystic fibrosis and is also a marker of pulmonary exacerbations. Our study showed that previous‐year i.v. use is a strong predictor of current‐year i.v. use. This finding could help clinicians to identify people most at risk of future exacerbation.
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Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Rachael Curley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael J Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Somayaji R, Ramos KJ, Kapnadak SG, Aitken ML, Goss CH. Common clinical features of CF (respiratory disease and exocrine pancreatic insufficiency). Presse Med 2017; 46:e109-e124. [PMID: 28554722 DOI: 10.1016/j.lpm.2017.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/06/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022] Open
Abstract
First described as a disease of the pancreas, cystic fibrosis is a genetically inherited progressive disease affecting multiple organ systems. Pulmonary and pancreatic involvement is common in individuals with cystic fibrosis, and the former is attributable to most of the mortality that occurs with the condition. This chapter provides an overview of a clinical approach to the pulmonary and pancreatic manifestations of cystic fibrosis.
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Affiliation(s)
- Ranjani Somayaji
- University of Calgary, Department of Medicine, Calgary, AB, Canada
| | - Kathleen J Ramos
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA
| | - Siddhartha G Kapnadak
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA
| | - Moira L Aitken
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA
| | - Christopher H Goss
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA; University of Washington, Department of Pediatrics, Division of Pediatric Pulmonology, Seattle, WA, USA; Seattle Children's Research Institute, Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle, WA, USA.
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29
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Nightingale JA, Osmond C. Does current reporting of lung function by the UK cystic fibrosis registry allow a fair comparison of adult centres? J Cyst Fibros 2017; 16:585-591. [PMID: 28462874 DOI: 10.1016/j.jcf.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outcome data for UK cystic fibrosis centres are publicly available in an annual report, which ranks centres by median FEV1% predicted. We wished to assess whether there are differences in lung function outcomes between adult centres that might imply differing standards of care. METHODS UK Registry data from 4761 subjects at 34 anonymised adult centres were used to calculate mean FEV1% and rate of change of lung function for 2007-13. These measures were used to rank centres and compare outcomes. RESULTS There are minor differences between centres for mean FEV1% for some years of the study and for rate of change of lung function over the study period. However, rankings are critically dependent on the outcome measure chosen and centre variation becomes negligible once patient population characteristics are taken into account. CONCLUSIONS We have demonstrated that the ranking of centres is biased and any apparent difference in respiratory outcomes is unlikely to be related to differing standards of care between centres.
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Affiliation(s)
- Julia Anne Nightingale
- Department of Adult Cystic Fibrosis, University Hospital Southampton NHS Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, United Kingdom.
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30
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Stephenson AL, Sykes J, Stanojevic S, Quon BS, Marshall BC, Petren K, Ostrenga J, Fink AK, Elbert A, Goss CH. Survival Comparison of Patients With Cystic Fibrosis in Canada and the United States: A Population-Based Cohort Study. Ann Intern Med 2017; 166:537-546. [PMID: 28288488 PMCID: PMC5467971 DOI: 10.7326/m16-0858] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In 2011, the median age of survival of patients with cystic fibrosis reported in the United States was 36.8 years, compared with 48.5 years in Canada. Direct comparison of survival estimates between national registries is challenging because of inherent differences in methodologies used, data processing techniques, and ascertainment bias. OBJECTIVE To use a standardized approach to calculate cystic fibrosis survival estimates and to explore differences between Canada and the United States. DESIGN Population-based study. SETTING 42 Canadian cystic fibrosis clinics and 110 U.S. cystic fibrosis care centers. PATIENTS Patients followed in the Canadian Cystic Fibrosis Registry (CCFR) and U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR) between 1990 and 2013. MEASUREMENTS Cox proportional hazards models were used to compare survival between patients followed in the CCFR (n = 5941) and those in the CFFPR (n = 45 448). Multivariable models were used to adjust for factors known to be associated with survival. RESULTS Median age of survival in patients with cystic fibrosis increased in both countries between 1990 and 2013; however, in 1995 and 2005, survival in Canada increased at a faster rate than in the United States (P < 0.001). On the basis of contemporary data from 2009 to 2013, the median age of survival in Canada was 10 years greater than in the United States (50.9 vs. 40.6 years, respectively). The adjusted risk for death was 34% lower in Canada than the United States (hazard ratio, 0.66 [95% CI, 0.54 to 0.81]). A greater proportion of patients in Canada received transplants (10.3% vs. 6.5%, respectively [standardized difference, 13.7]). Differences in survival between U.S. and Canadian patients varied according to U.S. patients' insurance status. LIMITATION Ascertainment bias due to missing data or nonrandom loss to follow-up might affect the results. CONCLUSION Differences in cystic fibrosis survival between Canada and the United States persisted after adjustment for risk factors associated with survival, except for private-insurance status among U.S. patients. Differential access to transplantation, increased posttransplant survival, and differences in health care systems may, in part, explain the Canadian survival advantage. PRIMARY FUNDING SOURCE U.S. Cystic Fibrosis Foundation.
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Affiliation(s)
- Anne L Stephenson
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Jenna Sykes
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Sanja Stanojevic
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Bradley S Quon
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Bruce C Marshall
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Kristofer Petren
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Josh Ostrenga
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Aliza K Fink
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Alexander Elbert
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
| | - Christopher H Goss
- From St. Michael's Hospital, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada; Cystic Fibrosis Foundation, Bethesda, Maryland; and University of Washington Medical Center, Seattle, Washington
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Konstan MW, McKone EF, Moss RB, Marigowda G, Tian S, Waltz D, Huang X, Lubarsky B, Rubin J, Millar SJ, Pasta DJ, Mayer-Hamblett N, Goss CH, Morgan W, Sawicki GS. Assessment of safety and efficacy of long-term treatment with combination lumacaftor and ivacaftor therapy in patients with cystic fibrosis homozygous for the F508del-CFTR mutation (PROGRESS): a phase 3, extension study. THE LANCET RESPIRATORY MEDICINE 2016; 5:107-118. [PMID: 28011037 DOI: 10.1016/s2213-2600(16)30427-1] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The 24-week safety and efficacy of lumacaftor/ivacaftor combination therapy was shown in two randomised controlled trials (RCTs)-TRAFFIC and TRANSPORT-in patients with cystic fibrosis who were aged 12 years or older and homozygous for the F508del-CFTR mutation. We aimed to assess the long-term safety and efficacy of extended lumacaftor/ivacaftor therapy in this group of patients in PROGRESS, the long-term extension of TRAFFIC and TRANSPORT. METHODS PROGRESS was a phase 3, parallel-group, multicentre, 96-week study of patients who completed TRAFFIC or TRANSPORT in 191 sites in 15 countries. Patients were eligible if they were at least 12 years old with cystic fibrosis and homozygous for the F508del-CFTR mutation. Exclusion criteria included any comorbidity or laboratory abnormality that, in the opinion of the investigator, might confound the results of the study or pose an additional risk in administering the study drug to the participant, history of drug intolerance, and history of poor compliance with the study drug. Patients who previously received active treatment in TRANSPORT or TRAFFIC remained on the same dose in PROGRESS. Patients who had received placebo in TRANSPORT or TRAFFIC were randomly assigned (1:1) to receive lumacaftor (400 mg every 12 h)/ivacaftor (250 mg every 12 h) or lumacaftor (600 mg once daily)/ivacaftor (250 mg every 12 h). The primary outcome was to assess the long-term safety of combined therapy. The estimated annual rate of decline in percent predicted FEV1 (ppFEV1) in treated patients was compared with that of a matched registry cohort. Efficacy analyses were based on modified intention-to-treat, such that data were included for all patients who were randomly assigned and received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT01931839. FINDINGS Between Oct 24, 2013, and April 7, 2016, 1030 patients from the TRANSPORT and TRAFFIC studies enrolled in PROGRESS, and 1029 received at least one dose of study drug. 340 patients continued treatment with lumacaftor 400 mg every 12 h/ivacaftor 250 mg every 12 h; 176 patients who had received placebo in the TRANSPORT or TRAFFIC studies initiated treatment with lumacaftor 400 mg every 12 h/ivacaftor 250 mg every 12 h, the commercially available dose, for which data are presented. The most common adverse events were infective pulmonary exacerbations, cough, increased sputum, and haemoptysis. Modest blood pressure increases seen in TRAFFIC and TRANSPORT were also observed in PROGRESS. For patients continuing treatment, the mean change from baseline in ppFEV1 was 0·5 (95% CI -0·4 to 1·5) at extension week 72 and 0·5 (-0·7 to 1·6) at extension week 96; change in BMI was 0·69 (0·56 to 0·81) at extension week 72 and 0·96 (0·81 to 1·11) at extension week 96. The annualised pulmonary exacerbation rate in patients continuing treatment through extension week 96 (0·65, 0·56 to 0·75) remained lower than the placebo rate in TRAFFIC and TRANSPORT. The annualised rate of ppFEV1 decline was reduced in lumacaftor/ivacaftor-treated patients compared with matched controls (-1·33, -1·80 to -0·85 vs -2·29, -2·56 to -2·03). The efficacy and safety profile of the lumacaftor 600 mg once daily/ivacaftor 250 mg every 12 h groups was generally similar to that of the lumacaftor 400 mg every 12 h/ivacaftor 250 mg every 12 h groups. INTERPRETATION The long-term safety profile of lumacaftor/ivacaftor combination therapy was consistent with previous RCTs. Benefits continued to be observed with longer-term treatment, and lumacaftor/ivacaftor was associated with a 42% slower rate of ppFEV1 decline than in matched registry controls. FUNDING Vertex Pharmaceuticals Incorporated.
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Affiliation(s)
- Michael W Konstan
- Case Western Reserve University School of Medicine and Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
| | | | | | | | - Simon Tian
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - David Waltz
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - Xiaohong Huang
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - Barry Lubarsky
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | - Jaime Rubin
- Vertex Pharmaceuticals Incorporated, Boston, MA, United States
| | | | - David J Pasta
- ICON Clinical Research, San Francisco, CA, United States
| | - Nicole Mayer-Hamblett
- Cystic Fibrosis Foundation, Bethesda, MD, United States; University of Washington, Seattle, WA, United States
| | | | - Wayne Morgan
- University of Arizona, Tucson, AZ, United States
| | - Gregory S Sawicki
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Salvatore D, Buzzetti R, Mastella G. An overview of international literature from cystic fibrosis registries. Part 5: Update 2012-2015 on lung disease. Pediatr Pulmonol 2016; 51:1251-1263. [PMID: 27163867 DOI: 10.1002/ppul.23473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/21/2016] [Accepted: 05/02/2016] [Indexed: 01/01/2023]
Abstract
Patient registry data is a tool for defining the clinical course and risk factors in patients with less common diseases like Cystic Fibrosis. Forty-one registry-based reports on lung disease in Cystic Fibrosis were published between 2011 and 2015. The aim of this review is to describe and discuss the results of these reports, focusing on the risk factors for lung disease progression, specific microbiologic pathogens (e.g., non-tuberculous mycobacteria), disease complications, comparisons between registries of different countries, the impact of socio-economic status, and evaluation of benefits and costs of therapies. Techniques for improved clinical trial design were also studied. Pediatr Pulmonol. 2016;51:1251-1263. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Roberto Buzzetti
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
| | - Gianni Mastella
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
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Heinzmann-Filho JP, Pinto LA, Marostica PJC, Donadio MVF. Variation in lung function is associated with worse clinical outcomes in cystic fibrosis. J Bras Pneumol 2016; 41:509-15. [PMID: 26785959 PMCID: PMC4723002 DOI: 10.1590/s1806-37562015000000006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 05/31/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine whether the variation in lung function over one year is associated with worse clinical outcomes, as well as with a decline in lung function in the following years, in patients with cystic fibrosis (CF). METHODS This was a retrospective study involving CF patients (4-19 years of age), evaluated over a three-year period. We evaluated demographic characteristics, chronic Pseudomonas aeruginosa infection, antibiotic use, hospitalization, six-minute walk distance (6MWD), and lung function. The inclusion criterion was having undergone pulmonary function testing at least three times in the first year and at least once in each of the next two years. RESULTS We evaluated 35 CF patients. The variation in FEV1 in the first year (ΔFEV1) was greater among those who, in the third year, showed reduced FEV1, had a below-average 6MWD, or were hospitalized than among those with normal FEV1, normal 6MWD, or no hospital admissions, in that same year (p < 0.05), although no such difference was found for antibiotic use in the third year. Subjects showing a ΔFEV1 ≥ 10% also showed a greater decline in FEV1 over the two subsequent years (p = 0.04). The ΔFEV1 also showed an inverse correlation with absolute FEV1 in the third year (r = -0.340, p = 0.04) and with the rate of FEV1 decline (r = -0.52, p = 0.001). Linear regression identified ΔFEV1 as a predictor of FEV1 decline (coefficient of determination, 0.27). CONCLUSIONS Significant variation in lung function over one year seems to be associated with a higher subsequent rate of FEV1 decline and worse clinical outcomes in CF patients. Short-term ΔFEV1 might prove useful as a predictor of CF progression in clinical practice.
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Affiliation(s)
- João Paulo Heinzmann-Filho
- Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Araujo Pinto
- Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Doull I. Cystic Fibrosis Papers of the Year 2015. Paediatr Respir Rev 2016; 20 Suppl:18-20. [PMID: 27475293 DOI: 10.1016/j.prrv.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies published in the last year have expanded our knowledge of potential disease modifying agents in the treatment of class II, III and IV CFTR mutations, and included the first report of an efficacious gene therapy for CF. There is also an important message on increasing use of conventional chronic therapies even in milder disease, and the pernicious effect of chronic infection on pulmonary function.
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Affiliation(s)
- Iolo Doull
- Department of Paediatric Respiratory Medicine and Paediatric, Cystic Fibrosis Centre, Children's Hospital for Wales, Cardiff, CF14 4XN, UK.
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35
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The Cystic Fibrosis Foundation Patient Registry. Design and Methods of a National Observational Disease Registry. Ann Am Thorac Soc 2016; 13:1014-5. [PMID: 27388403 DOI: 10.1513/annalsats.201604-250ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Savant AP, McColley SA. Pediatric Pulmonology year in review 2015: Part 4. Pediatr Pulmonol 2016; 51:754-65. [PMID: 27171478 DOI: 10.1002/ppul.23470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/02/2016] [Indexed: 11/06/2022]
Abstract
In this article, we highlight cystic fibrosis (CF) research published in Pediatric Pulmonology during 2015. Articles from other journals that reflect similar themes, and those of special importance, are also included. Pediatr Pulmonol. 2016;51:754-765. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Adrienne P Savant
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Division of Pulmonary Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Stanley Manne Children's Research Institute, Chicago, Illinois
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Grigg J, Barben J, Bohlin K, Everard ML, Hall G, Pijnenburg M, Priftis KN, Rusconi F, Midulla F. Key paediatric messages from Amsterdam. ERJ Open Res 2016; 2:00020-2016. [PMID: 27730186 PMCID: PMC5005169 DOI: 10.1183/23120541.00020-2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/28/2016] [Indexed: 11/05/2022] Open
Abstract
The Paediatric Assembly of the European Respiratory Society (ERS) maintained its high profile at the 2015 ERS International Congress in Amsterdam. There were symposia on preschool wheeze, respiratory sounds and cystic fibrosis; an educational skills workshop on paediatric respiratory resuscitation; a hot topic session on risk factors and early origins of respiratory diseases; a meet the expert session on paediatric lung function test reference values; and the annual paediatric grand round. In this report the Chairs of the Paediatric Assembly's Groups highlight the key messages from the abstracts presented at the Congress.
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Affiliation(s)
- Jonathan Grigg
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Jürg Barben
- Division of Paediatric Pulmonology, Children's Hospitals of Eastern Switzerland, St. Gallen, Switzerland
| | - Kajsa Bohlin
- Division of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Mark L. Everard
- School of Paediatrics and Child Health, The University of Western Australia, Crawley, Australia
| | | | - Mariëlle Pijnenburg
- Dept of Pediatric Respiratory Medicine, Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kostas N. Priftis
- Children's Respiratory and Allergy Unit, Third Dept of Paediatrics, “Attikon” Hospital, University of Athens Medical School, Athens, Greece
| | | | - Fabio Midulla
- Dipartimento di Pediatria e Neuropsichiatria Infantile, Ospedale Policlinico Umberto I, Rome, Italy
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Hauschild DB, Barbosa E, Moreira EAM, Ludwig Neto N, Platt VB, Piacentini Filho E, Wazlawik E, Moreno YMF. Nutrition Status Parameters and Hydration Status by Bioelectrical Impedance Vector Analysis Were Associated With Lung Function Impairment in Children and Adolescents With Cystic Fibrosis. Nutr Clin Pract 2016; 31:378-86. [DOI: 10.1177/0884533615627157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Daniela Barbieri Hauschild
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eliana Barbosa
- Joana de Gusmão Children’s Hospital, Florianópolis, Brazil
| | - Emilia Addison Machado Moreira
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | | | - Elisabeth Wazlawik
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Yara Maria Franco Moreno
- Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
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Jo HE, Corte TJ, Wort SJ, Eves ND, Piper A, Wainwright C. Year in review 2015: Interstitial lung disease, pulmonary vascular disease, pulmonary function, sleep and ventilation, cystic fibrosis and paediatric lung disease. Respirology 2016; 21:556-66. [DOI: 10.1111/resp.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Helen E. Jo
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
| | - Tamera J. Corte
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- University of Sydney; Sydney New South Wales Australia
| | - Stephen J. Wort
- Department of Pulmonary Hypertension; Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London; London UK
| | - Neil D. Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development; University of British Columbia; Kelowna British Columbia Canada
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Woolcock Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - Claire Wainwright
- Lady Cilento Children's Hospital, School of Medicine; University of Queensland; Brisbane Queensland Australia
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Nichols DP, Kuk KN, Nick JA. Drug interactions and treatment burden as survival improves. Curr Opin Pulm Med 2016; 21:617-25. [PMID: 26390336 DOI: 10.1097/mcp.0000000000000212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW With our growing understanding of the pathophysiology of cystic fibrosis, the pace of drug discovery is accelerating. Newer agents and therapies have traditionally been added to available medications, given the urgency in treating the disease. As the cystic fibrosis population ages, the number of associated comorbidities increases, requiring additional therapeutic approaches. Thus, while current management strategies have dramatically extended projected life expectancy, the treatment burden of the disease in adulthood has become onerous, and there is increasing concern over unintended effects and drug-drug interactions of new and existing therapies. RECENT FINDINGS A number of recent studies have sought to quantify the treatment burden of cystic fibrosis care, and to identify ways to reduce this burden. Mechanistic studies have identified the potential for a number of cystic fibrosis medications to impair the host response, or to interfere with the efficacy of other agents. SUMMARY As the cystic fibrosis formulary grows, a primary emphasis will be for providers to develop personalized treatment plans, with a goal to reduce unnecessary treatment burden and an awareness of potential unanticipated effects of medications.
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Affiliation(s)
- David P Nichols
- aDepartment of Pediatrics bDepartment of Medicine, National Jewish Health cDepartment of Pharmacy, St. Joseph Hospital SCL Health, Denver dDepartment of Medicine eDepartment of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Country to country variation: what can be learnt from national cystic fibrosis registries. Curr Opin Pulm Med 2016; 21:585-90. [PMID: 26390334 DOI: 10.1097/mcp.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW This review will address the evolving science involving international comparisons of populations of persons living with cystic fibrosis. Understanding the current clinical outcomes in cystic fibrosis is critical prior to assessing such comparisons. Countries that differ in clinical approaches provide natural experiments to assess those approaches. RECENT FINDINGS Recent studies have highlighted that the population of persons with cystic fibrosis is changing; estimates predict a continued growth of cystic fibrosis populations with substantial increases in persons with cystic fibrosis who are adults. Additional work highlighted differences in subpopulations (i.e. children); US cystic fibrosis children appear to have better lung function, but similar nutritional status, compared to UK cystic fibrosis children. These differences were associated with differences in intensity of care, with a higher proportion of US children receiving more cystic fibrosis-specific therapies. Additional research raises important questions regarding potential sampling bias in different patient registries and differing rates of unconfirmed cases of cystic fibrosis. These and other limitations are highlighted. SUMMARY Differences in both demographics and clinical outcomes in cystic fibrosis between nations can be informative, but, like many types of observational research, are at risk of unrecognized bias. Despite this limitation, these comparisons can lead to substantive improvements in care in cystic fibrosis.
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Pritchard MF, Powell LC, Menzies GE, Lewis PD, Hawkins K, Wright C, Doull I, Walsh TR, Onsøyen E, Dessen A, Myrvold R, Rye PD, Myrset AH, Stevens HNE, Hodges LA, MacGregor G, Neilly JB, Hill KE, Thomas DW. A New Class of Safe Oligosaccharide Polymer Therapy To Modify the Mucus Barrier of Chronic Respiratory Disease. Mol Pharm 2016; 13:863-72. [PMID: 26833139 DOI: 10.1021/acs.molpharmaceut.5b00794] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The host- and bacteria-derived extracellular polysaccharide coating of the lung is a considerable challenge in chronic respiratory disease and is a powerful barrier to effective drug delivery. A low molecular weight 12-15-mer alginate oligosaccharide (OligoG CF-5/20), derived from plant biopolymers, was shown to modulate the polyanionic components of this coating. Molecular modeling and Fourier transform infrared spectroscopy demonstrated binding between OligoG CF-5/20 and respiratory mucins. Ex vivo studies showed binding induced alterations in mucin surface charge and porosity of the three-dimensional mucin networks in cystic fibrosis (CF) sputum. Human studies showed that OligoG CF-5/20 is safe for inhalation in CF patients with effective lung deposition and modifies the viscoelasticity of CF-sputum. OligoG CF-5/20 is the first inhaled polymer therapy, represents a novel mechanism of action and therapeutic approach for the treatment of chronic respiratory disease, and is currently in Phase IIb clinical trials for the treatment of CF.
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Affiliation(s)
- Manon F Pritchard
- Advanced Therapies Group, School of Dentistry, Cardiff University , Cardiff CF14 4XY, U.K
| | - Lydia C Powell
- Advanced Therapies Group, School of Dentistry, Cardiff University , Cardiff CF14 4XY, U.K
| | | | | | | | | | - Iolo Doull
- Respiratory/Cystic Fibrosis Unit, Children's Hospital for Wales , Cardiff CF14 4XW, U.K
| | - Timothy R Walsh
- Medical Microbiology, School of Medicine, College of Biomedical and Life Sciences, Cardiff University , Cardiff CF14 4EP, U.K
| | | | | | | | | | | | | | - Lee A Hodges
- Bio-Images Drug Delivery Ltd., Glasgow G4 0SF, U.K
| | | | | | - Katja E Hill
- Advanced Therapies Group, School of Dentistry, Cardiff University , Cardiff CF14 4XY, U.K
| | - David W Thomas
- Advanced Therapies Group, School of Dentistry, Cardiff University , Cardiff CF14 4XY, U.K
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Zampoli M, Pillay K, Carrara H, Zar HJ, Morrow B. Microbiological yield from induced sputum compared to oropharyngeal swab in young children with cystic fibrosis. J Cyst Fibros 2016; 15:605-10. [PMID: 26825010 DOI: 10.1016/j.jcf.2016.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Standard respiratory sampling in young children with cystic fibrosis (CF) is by oropharyngeal swab (OPS) as they cannot spontaneously expectorate. Sputum induction (IS) has been poorly investigated in this population. We aimed to compare the bacteriological yield of OPS vs. IS in young children with CF. METHODS Sequentially paired OPS followed by IS samples was collected in children <5years of age attending a CF clinic in Cape Town, South Africa. RESULTS IS was successfully paired with OPS in 98/113 (85%) attempts in 32 children (mean±SD 19±16months), with no serious adverse events. IS culture yield for any CF-associated bacteria from IS was 46% vs. 28% from OPS (p=0.01). The sensitivity, specificity, PPV and NPV of OPS compared to IS in isolating CF-associated bacteria were 56%, 96%, 93%, and 72% respectively. CONCLUSION Sputum induction is feasible, safe and superior to OPS for detecting CF-associated bacteria in young children with CF.
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Affiliation(s)
- Marco Zampoli
- Department of Paediatrics and Child Health, Division of Pediatric Pulmonology, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Komala Pillay
- Department of Anatomical Pathology, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Henri Carrara
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - Brenda Morrow
- Department of Paediatrics and Child Health, Division of Pediatric Pulmonology, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
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Ribeiro JD, Fischer GB. Chronic obstructive pulmonary diseases in children. J Pediatr (Rio J) 2015; 91:S11-25. [PMID: 26354868 DOI: 10.1016/j.jped.2015.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To verify and describe the main events related to the diagnosis and management of chronic obstructive pulmonary diseases in children (COPDC) and adolescents, considering the interrelated physiopathology, genetic, and environmental characteristics. SOURCES Relevant literature from PubMed was selected and reviewed. SUMMARY OF THE FINDINGS COPDC have an environmental and/or genetic origin and its manifestation has manifold genotypes, phenotypes, and endotypes. Although COPDC has no cure, it can be clinically controlled. Chronic cough is the main symptom and bronchiectasis can be present in several COPDC patients. The management of COPDC is more effective if based on guidelines and when treatment regimen adherence is promoted. Oral and inhaled corticosteroids, bronchodilators, inhaled antibiotics, and treatment of pulmonary exacerbation (PE) are the bases of COPDC management, and should be individualized for each patient. CONCLUSIONS Correct diagnosis and knowledge of risk factors and comorbidities are essential in COPDC management. Procedures and drugs used should be based on specific guidelines for each COPDC case. Treatment adherence is critical to obtain the benefits of management. COPDC clinical control must be evaluated by the decrease in PEs, improved quality of life, reduction of pulmonary function loss, and lung structural damage. For most cases of COPDC, monitoring by interdisciplinary teams in specialized reference centers with surveillance strategies and continuous care leads to better outcomes, which must be evaluated by decreasing pulmonary function damage and deterioration, better prognosis, better quality life, and increased life expectancy.
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Affiliation(s)
- Jose Dirceu Ribeiro
- Department of Pediatrics, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.
| | - Gilberto Bueno Fischer
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Ribeiro JD, Fischer GB. Chronic obstructive pulmonary diseases in children. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sawicki GS, McKone EF, Pasta DJ, Millar SJ, Wagener JS, Johnson CA, Konstan MW. Sustained Benefit from Ivacaftor Demonstrated by Combining Clinical Trial and Cystic Fibrosis Patient Registry Data. Am J Respir Crit Care Med 2015; 192:836-42. [DOI: 10.1164/rccm.201503-0578oc] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Cystic fibrosis is an autosomal recessive, monogenetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The gene defect was first described 25 years ago and much progress has been made since then in our understanding of how CFTR mutations cause disease and how this can be addressed therapeutically. CFTR is a transmembrane protein that transports ions across the surface of epithelial cells. CFTR dysfunction affects many organs; however, lung disease is responsible for the vast majority of morbidity and mortality in patients with cystic fibrosis. Prenatal diagnostics, newborn screening and new treatment algorithms are changing the incidence and the prevalence of the disease. Until recently, the standard of care in cystic fibrosis treatment focused on preventing and treating complications of the disease; now, novel treatment strategies directly targeting the ion channel abnormality are becoming available and it will be important to evaluate how these treatments affect disease progression and the quality of life of patients. In this Primer, we summarize the current knowledge, and provide an outlook on how cystic fibrosis clinical care and research will be affected by new knowledge and therapeutic options in the near future. For an illustrated summary of this Primer, visit: http://go.nature.com/4VrefN.
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Jakubovics NS, Burgess JG. Extracellular DNA in oral microbial biofilms. Microbes Infect 2015; 17:531-7. [PMID: 25862975 DOI: 10.1016/j.micinf.2015.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 12/12/2022]
Abstract
The extracellular matrix of microbial biofilms is critical for surface adhesion and nutrient homeostasis. Evidence is accumulating that extracellular DNA plays a number of important roles in biofilm integrity and formation on hard and soft tissues in the oral cavity. Here, we summarise recent developments in the field and consider the potential of targeting DNA for oral biofilm control.
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Affiliation(s)
| | - J Grant Burgess
- School of Marine Science and Technology, Newcastle University, UK
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Affiliation(s)
- David C Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK UCL Institute of Child Health, London, UK
| | - Michael S Schechter
- Department of Pediatrics, Division of Pulmonary Medicine, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
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