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Bugenhagen SM, Grant JCE, Rosenbluth DB, Bhalla S. Update on the Role of Chest Imaging in Cystic Fibrosis. Radiographics 2024; 44:e240008. [PMID: 39172707 DOI: 10.1148/rg.240008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Cystic fibrosis is a genetic disease with multisystem involvement and associated morbidity and mortality that are most directly related to progressive lung disease. The hallmark findings of cystic fibrosis in the lungs are chronic inflammation and infection, leading to progressive loss of pulmonary function and often requiring lung transplant. Predominant lung findings include mucous plugging, bronchiectasis, and air trapping, often with associated atelectasis, consolidation, and emphysema; these findings form the basis of several clinical scoring systems that are used for imaging assessment. Recently, there have been major breakthroughs in the pharmacologic management of cystic fibrosis, including highly effective modulator therapies that directly target the underlying cystic fibrosis transmembrane conductance regulator molecular defect, often leading to remarkable improvements in lung function and quality of life with corresponding significant improvements in imaging markers. The authors review current guidelines regarding cystic fibrosis with respect to disease monitoring, identifying complications, and managing advanced lung disease. In addition, they discuss the evolving role of imaging, including current trends, emerging technologies, and proposed updates to imaging guidelines endorsed by international expert committees on cystic fibrosis, which favor increased use of cross-sectional imaging to enable earlier detection of structural changes in early disease and more sensitive detection of acute changes in advanced disease. It is important for radiologists to be familiar with these trends and updates so that they can most effectively assist clinicians in guiding the management of patients with cystic fibrosis in all stages of disease. ©RSNA, 2024.
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Affiliation(s)
- Scott M Bugenhagen
- From the Mallinckrodt Institute of Radiology (S.M.B, J.C.E.G, S.B.) and Department of Medicine (D.B.R.), Washington University, 660 S Euclid Ave, St. Louis, MO 63110
| | - Jacob C E Grant
- From the Mallinckrodt Institute of Radiology (S.M.B, J.C.E.G, S.B.) and Department of Medicine (D.B.R.), Washington University, 660 S Euclid Ave, St. Louis, MO 63110
| | - Daniel B Rosenbluth
- From the Mallinckrodt Institute of Radiology (S.M.B, J.C.E.G, S.B.) and Department of Medicine (D.B.R.), Washington University, 660 S Euclid Ave, St. Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology (S.M.B, J.C.E.G, S.B.) and Department of Medicine (D.B.R.), Washington University, 660 S Euclid Ave, St. Louis, MO 63110
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2
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Mall MA, Burgel PR, Castellani C, Davies JC, Salathe M, Taylor-Cousar JL. Cystic fibrosis. Nat Rev Dis Primers 2024; 10:53. [PMID: 39117676 DOI: 10.1038/s41572-024-00538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/10/2024]
Abstract
Cystic fibrosis is a rare genetic disease caused by mutations in CFTR, the gene encoding cystic fibrosis transmembrane conductance regulator (CFTR). The discovery of CFTR in 1989 has enabled the unravelling of disease mechanisms and, more recently, the development of CFTR-directed therapeutics that target the underlying molecular defect. The CFTR protein functions as an ion channel that is crucial for correct ion and fluid transport across epithelial cells lining the airways and other organs. Consequently, CFTR dysfunction causes a complex multi-organ disease but, to date, most of the morbidity and mortality in people with cystic fibrosis is due to muco-obstructive lung disease. Cystic fibrosis care has long been limited to treating symptoms using nutritional support, airway clearance techniques and antibiotics to suppress airway infection. The widespread implementation of newborn screening for cystic fibrosis and the introduction of a highly effective triple combination CFTR modulator therapy that has unprecedented clinical benefits in up to 90% of genetically eligible people with cystic fibrosis has fundamentally changed the therapeutic landscape and improved prognosis. However, people with cystic fibrosis who are not eligible based on their CFTR genotype or who live in countries where they do not have access to this breakthrough therapy remain with a high unmet medical need.
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Affiliation(s)
- Marcus A Mall
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität, Berlin, Germany.
- German Centre for Lung Research (DZL), Associated Partner Site Berlin, Berlin, Germany.
- German Center for Child and Adolescent Health (DZKJ), Partner Site Berlin, Berlin, Germany.
| | - Pierre-Régis Burgel
- Université Paris Cité and Institut Cochin, Inserm U1016, Paris, France
- Department of Respiratory Medicine and National Reference Center for Cystic Fibrosis, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Carlo Castellani
- IRCCS Istituto Giannina Gaslini, Cystic Fibrosis Center, Genoa, Italy
| | - Jane C Davies
- National Heart & Lung Institute, Imperial College London, London, UK
- St Thomas' NHS Trust, London, UK
- Royal Brompton Hospital, Part of Guy's & St Thomas' Trust, London, UK
| | - Matthias Salathe
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Jennifer L Taylor-Cousar
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
- Division of Paediatric Pulmonary Medicine, National Jewish Health, Denver, CO, USA
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3
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Burgel PR, Southern KW, Addy C, Battezzati A, Berry C, Bouchara JP, Brokaar E, Brown W, Azevedo P, Durieu I, Ekkelenkamp M, Finlayson F, Forton J, Gardecki J, Hodkova P, Hong G, Lowdon J, Madge S, Martin C, McKone E, Munck A, Ooi CY, Perrem L, Piper A, Prayle A, Ratjen F, Rosenfeld M, Sanders DB, Schwarz C, Taccetti G, Wainwright C, West NE, Wilschanski M, Bevan A, Castellani C, Drevinek P, Gartner S, Gramegna A, Lammertyn E, Landau EEC, Plant BJ, Smyth AR, van Koningsbruggen-Rietschel S, Middleton PG. Standards for the care of people with cystic fibrosis (CF); recognising and addressing CF health issues. J Cyst Fibros 2024; 23:187-202. [PMID: 38233247 DOI: 10.1016/j.jcf.2024.01.005] [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] [Received: 11/06/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
This is the third in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on recognising and addressing CF health issues. The guidance was produced with wide stakeholder engagement, including people from the CF community, using an evidence-based framework. Authors contributed sections, and summary statements which were reviewed by a Delphi consultation. Monitoring and treating airway infection, inflammation and pulmonary exacerbations remains important, despite the widespread availability of CFTR modulators and their accompanying health improvements. Extrapulmonary CF-specific health issues persist, such as diabetes, liver disease, bone disease, stones and other renal issues, and intestinal obstruction. These health issues require multidisciplinary care with input from the relevant specialists. Cancer is more common in people with CF compared to the general population, and requires regular screening. The CF life journey requires mental and emotional adaptation to psychosocial and physical challenges, with support from the CF team and the CF psychologist. This is particularly important when life gets challenging, with disease progression requiring increased treatments, breathing support and potentially transplantation. Planning for end of life remains a necessary aspect of care and should be discussed openly, honestly, with sensitivity and compassion for the person with CF and their family. CF teams should proactively recognise and address CF-specific health issues, and support mental and emotional wellbeing while accompanying people with CF and their families on their life journey.
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Affiliation(s)
- Pierre-Régis Burgel
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Institut Cochin, Inserm U1016, Université Paris-Cité, Paris, France
| | - Kevin W Southern
- Department of Women's and Children's Health, Institute in the Park, Alder Hey Children's Hospital, University of Liverpool, Eaton Road, Liverpool L12 2AP, UK.
| | - Charlotte Addy
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alberto Battezzati
- Clinical Nutrition Unit, Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, and ICANS-DIS, Department of Food Environmental and Nutritional Sciences, University of Milan, Milan, Italy
| | - Claire Berry
- Department of Nutrition and Dietetics, Alder Hey Children's NHS Trust, Liverpool, UK
| | - Jean-Philippe Bouchara
- University of Brest, Fungal Respiratory Infections Research Unit, SFR ICAT, University of Angers, Angers, France
| | - Edwin Brokaar
- Department of Pharmacy, Haga Teaching Hospital, The Hague, the Netherlands
| | - Whitney Brown
- Cystic Fibrosis Foundation, Inova Fairfax Hospital, Bethesda, Maryland, USA, Falls Church, VA, USA
| | - Pilar Azevedo
- Cystic Fibrosis Reference Centre-Centro, Hospitalar Universitário Lisboa Norte, Portugal
| | - Isabelle Durieu
- Cystic Fibrosis Reference Center (Constitutif), Service de médecine interne et de pathologie vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, RESearch on HealthcAre PErformance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69373 Lyon Cedex 08, France; ERN-Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Miquel Ekkelenkamp
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Felicity Finlayson
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
| | | | - Johanna Gardecki
- CF Centre at Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Pavla Hodkova
- CF Center at University Hospital Motol, Prague, Czech Republic
| | - Gina Hong
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jacqueline Lowdon
- Clinical Specialist Paediatric Cystic Fibrosis Dietitian, Leeds Children's Hospital, UK
| | - Su Madge
- Royal Brompton Hospital, Part of Guys and StThomas's Hospital, London, UK
| | - Clémence Martin
- Institut Cochin, Inserm U1016, Université Paris-Cité and National Reference Center for Cystic Fibrosis, Hôpital Cochin AP-HP, ERN-Lung CF Network, Paris 75014, France
| | - Edward McKone
- St.Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Anne Munck
- Hospital Necker Enfants-Malades, AP-HP, CF Centre, Université Paris Descartes, Paris, France
| | - Chee Y Ooi
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, Faculty of Medicine & Health, Department of Gastroenterology, Sydney Children's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Perrem
- Department of Respiratory Medicine, Children's Health Ireland, Dublin, Ireland
| | - Amanda Piper
- Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Andrew Prayle
- Child Health, Lifespan and Population Health & Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics and Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Margaret Rosenfeld
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Don B Sanders
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carsten Schwarz
- Division Cystic Fibrosis, CF Center, Clinic Westbrandenburg, HMU-Health and Medical University, Potsdam, Germany
| | - Giovanni Taccetti
- Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Centre, Italy
| | | | - Natalie E West
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, CF Center, Hadassah Medical Center, Jerusalem, Israel
| | - Amanda Bevan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Carlo Castellani
- IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, Genova 16147, Italy
| | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Silvia Gartner
- Cystic Fibrosis Unit and Pediatric Pulmonology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Respiratory Unit and Adult Cystic Fibrosis Center, Università degli Studi di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elise Lammertyn
- Cystic Fibrosis Europe, Brussels, Belgium and the Belgian CF Association, Brussels, Belgium
| | - Eddie Edwina C Landau
- The Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Barry J Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, University College Cork, Ireland
| | - Alan R Smyth
- School of Medicine, Dentistry and Biomedical Sciences, Belfast and NIHR Nottingham Biomedical Research Centre, Queens University Belfast, Nottingham, UK
| | | | - Peter G Middleton
- Westmead Clinical School, Department Respiratory & Sleep Medicine, Westmead Hospital, University of Sydney and CITRICA, Westmead, Australia
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Dohna M, Kühl H, Sutharsan S, Bruns N, Vo Chieu VD, Hellms S, Kornemann N, Montag MJ. Morphological chest CT changes in cystic fibrosis and massive hemoptysis. RADIOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00117-024-01266-4. [PMID: 38326635 DOI: 10.1007/s00117-024-01266-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Massive hemoptysis (MH) is a rare but potentially life-threatening condition of patients with mainly advanced cystic fibrosis (CF). Morphological lung changes are aggravated with disease progression. The aim of this study was to determine whether morphological lung changes differ between patients with CF (pwCF) who have MH and pwCF without MH. METHODS Chest computed tomography (CT) scans of pwCF and MH acquired at a maximum of 4 months prior to MH (1/2008 to 2/2015) were evaluated for morphological changes and bronchial artery (BA) diameters. Lung lobes with MH were compared with lobes without MH and with matched control patients with end-stage CF and no hemoptysis using the Helbich scoring system. RESULTS The study included 26 patients with MH (PMH; 15 female, median age 29 years, interquartile range [IQR]: 25-33.75) and 17 matched control patients (11 male, median age 24 years, IQR: 19.5-30). No difference in Helbich score was detected between lobes with MH and matched control patients (p = 0.051). Higher scores were detected in lobes with MH compared to lobes without MH in PMH (p = 0.021), but no difference was detected in the subscores. The BA diameters were larger in PMH (p = 0.02); 85% of PMH had unilateral MH, with 65% of MH involving only one or two lobes. CONCLUSION Morphological changes are more severe in lobes with MH in the same patient, but there is no difference when compared with matched control patients. Besides abscess/sacculation, no specific changes for MH were identified. Other factors such as BA hypertrophy might play a pivotal role in the pathogenesis of MH in pwCF. Commonly used scores to evaluate chest CT in pwCF cannot be used to assess MH, and other factors, e.g., hypertrophied BA, not represented and not measured in these scores, might be more suitable for assessing the risk for MH.
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Affiliation(s)
- Martha Dohna
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Clinic for diagnostic and interventional Radiology, University Hospital Bonn, Bonn, Germany, Venusberg-Campus 1, 53127.
| | - Hilmar Kühl
- St. Bernhard-Hospital Kamp-Lintfort, Bürgermeister-Schmelzing-Str. 90, 47475, Kamp-Lintfort, Germany
| | - Sivagurunathan Sutharsan
- Division of Cystic Fibrosis, Department of Pulmonary Medicine, University Medicine Essen -Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, University Medicine Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Van Dai Vo Chieu
- St. Vicenz-Hospital Paderborn, Am Busdorf 2, 33098, Paderborn, Germany
| | - Susanne Hellms
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Norman Kornemann
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael J Montag
- Clinic for Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Gilboy JW, O'Brien D, Zuckerman JB. Unusual Cause of Hemoptysis in a Woman With Cystic Fibrosis. Chest 2024; 165:e33-e37. [PMID: 38336441 DOI: 10.1016/j.chest.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 02/12/2024] Open
Abstract
CASE PRESENTATION A 20-year-old patient with cystic fibrosis (CF) complicated by pansinusitis, pancreatic insufficiency, and diabetes presented to the local ED after an episode of large-volume hemoptysis at home. At baseline, she had advanced lung disease (FEV1, 0.97 L; 31% predicted) and upper lobe-predominant fibrocavitary changes. She was intermittently followed at a regional lung transplant center. She was previously evaluated for transplant but was not listed at the time of this presentation because of nontuberculous mycobacteria infection. She had never used tobacco, without reports of recreational inhaled drug use. Her mother had CF, and one of her brothers died in 2018 at age 24 of respiratory failure resulting from the disease.
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Affiliation(s)
| | - D O'Brien
- Northern Light Eastern Maine Medical Center, Bangor, ME
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6
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Bayomy OF, Bradford MC, Milinic T, Kapnadak SG, Morrell ED, Lease ED, Goss CH, Ramos KJ. Lung Allocation Score Exceptions in Persons with Cystic Fibrosis Undergoing Lung Transplant. Ann Am Thorac Soc 2024; 21:271-278. [PMID: 37878995 PMCID: PMC10848912 DOI: 10.1513/annalsats.202306-509oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023] Open
Abstract
Rationale: Lung transplantation can extend the lives of individuals with advanced cystic fibrosis (CF). Until March 2023, the Lung Allocation Score (LAS) was used in the United States to determine transplant priority. Certain clinical events or attributes ("risk events") that are not included in the LAS (e.g., massive hemoptysis) are relatively common and prognostically important in CF and may prompt an exception request to increase priority for donor lungs. The new Lung Composite Allocation Score (CAS) also allows for exceptions based on the same principles. Objectives: To evaluate the frequency of LAS exceptions in persons with CF (PwCFs) listed for lung transplantation and assess whether LAS exceptions are associated with improved waitlist outcomes for PwCFs compared with similarly "at-risk" individuals without LAS exceptions. Methods: A merged dataset combining data from the CF Foundation Patient Registry and the Organ Procurement and Transplantation Network (2005-2019) was used to identify PwCFs listed for lung transplantation. We compared waitlist outcomes between PwCFs with a LAS exception versus those without an exception despite having a risk event. Risk events were defined as an episode of massive hemoptysis, pneumothorax, at least three moderate/severe pulmonary exacerbations, and/or a decrease in forced expiratory volume in 1 second by ⩾30% predicted (absolute) in the prior 12 months. Analyses were performed using competing risk regression with time to transplantation as the primary outcome and death without a transplant as a competing risk. Results: Of 3,538 listings from 3,309 candidates, 2% of listings (n = 81) had at least one exception. Candidates with an exception and those with a risk event but no exception received lung transplants more slowly than people without an exception or risk event (subdistribution hazard ratio [95% confidence interval]: LAS exception cohort, 0.66 [0.52-0.85]; risk event cohort without exceptions, 0.79 [0.72-0.86]). There was no difference between those with LAS exceptions and those at risk without LAS exceptions: subdistribution hazard ratio, 0.84 (0.66-1.08). Conclusions: LAS exceptions are rare in PwCFs listed for lung transplantation. LAS exceptions resulted in a similar time to transplantation for PwCFs compared with similarly at-risk individuals. As we enter the CAS era, these LAS-based results are pertinent to improve risk stratification among PwCFs being considered for lung transplantation.
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Affiliation(s)
- Omar F. Bayomy
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | - Miranda C. Bradford
- Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Tijana Milinic
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | | | - Eric D. Morrell
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | - Erika D. Lease
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
| | - Christopher H. Goss
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
- Division of Pulmonary Medicine, Department of Pediatrics, University of Washington, Seattle, Washington; and
| | - Kathleen J. Ramos
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and
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Carter C, Kahai R, Cunningham J, Kilduff J, Hough N, Baxter C, Connell D, Shah A. Chronic pulmonary aspergillosis - a guide for the general physician. Clin Med (Lond) 2024; 24:100019. [PMID: 38281665 PMCID: PMC11024841 DOI: 10.1016/j.clinme.2024.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This collaborative article presents a review of chronic pulmonary aspergillosis (CPA) from the perspective of a multidisciplinary team comprising of respiratory physicians, radiologists, mycologists, dietitians, pharmacists, physiotherapists and palliative care specialists. The review synthesises current knowledge on CPA, emphasising the intricate interplay between clinical, radiological, and microbiological aspects. We highlight the importance of assessing each patient as multidisciplinary team to ensure personalised treatment strategies and a holistic approach to patient care.
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Affiliation(s)
- Charlotte Carter
- Registrar in respiratory medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Rasleen Kahai
- Respiratory dietitian, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Josie Cunningham
- Pharmacist independent prescriber, Frimley Park NHS Foundation Trust, Frimley, UK
| | - Jennifer Kilduff
- Physiotherapist in respiratory medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Natasha Hough
- Consultant physician in respiratory medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Caroline Baxter
- Consultant physician in respiratory medicine, National Aspergillosis Centre, Manchester NHS Foundation Trust, Manchester, UK
| | - David Connell
- Consultant physician in respiratory medicine, NHS Tayside, Dundee, UK
| | - Anand Shah
- Consultant physician in respiratory medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK, and MRC Centre of Global Infectious Disease Analysis, Imperial College London, London, UK
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8
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Alkazemi A, Kovacevic M, Dube K, Lauffenburger JC, Smith A, Malinowski S, Weinhouse GL. Effectiveness of Nebulized Tranexamic Acid in Patients with Moderate-to-Massive Hemoptysis at a Tertiary Academic Medical Center. J Aerosol Med Pulm Drug Deliv 2023; 36:309-315. [PMID: 37962861 DOI: 10.1089/jamp.2022.0038] [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: 11/15/2023] Open
Abstract
Introduction: The management of severe hemoptysis mainly consists of invasive interventional procedures, including angiographic bronchial artery embolization, various endobronchial interventions, and sometimes surgery. However, there are limited effective noninvasive medical therapies available. The objective of this analysis was to evaluate the effectiveness and safety of nebulized tranexamic acid (TXA) administration compared with conventional management in patients with hemoptysis. Methods: This Institutional Review Board-approved, single-center, retrospective matched cohort study was performed from January 1, 2018 to March 31, 2021. Electronic health record data were used to identify all adult inpatients with hemoptysis (International Classification of Diseases, Tenth Revision, code R04.2). All patients who received ≥1 dose of nebulized TXA were matched with up to five controls based on available severity criteria (hemoptysis severity, need for mechanical ventilation, and sequential organ failure assessment score at the time of hemoptysis diagnosis) with coarsened exact matching. The primary outcome was the need for invasive interventions for the management of hemoptysis. Secondary outcomes included time to hemoptysis resolution, duration of mechanical ventilation, hemoptysis recurrence, and hospital length of stay. Results: A total of 14 patients were treated with nebulized TXA; they were matched with 58 controls. Patients were 59.7% male, had a median age of 65.5 years, with airway disease (36.1%) being the major etiology of hemoptysis. There was no difference in the number of patients who required an invasive intervention between the TXA (35.7%) versus control group (56.9%), p = 0.344. Additionally, no difference was found in the time to hemoptysis resolution (p = 0.050), duration on mechanical ventilation (p = 0.128), hemoptysis recurrence (p = 1.000), or hospital length of stay (p = 0.139). Conclusions: In patients with hemoptysis, nebulized TXA may be considered as a noninvasive option for the management of hemoptysis. However, a larger analysis is warranted to determine the impact of nebulized TXA on invasive interventions for management.
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Affiliation(s)
- Afrah Alkazemi
- Department of Pharmacy Practice, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Mary Kovacevic
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Dube
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adam Smith
- Department of Respiratory Therapy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephen Malinowski
- Department of Respiratory Therapy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gerald L Weinhouse
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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9
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Wucherpfennig L, Triphan SMF, Wege S, Kauczor HU, Heussel CP, Sommerburg O, Stahl M, Mall MA, Eichinger M, Wielpütz MO. Elexacaftor/Tezacaftor/Ivacaftor Improves Bronchial Artery Dilatation Detected by Magnetic Resonance Imaging in Patients with Cystic Fibrosis. Ann Am Thorac Soc 2023; 20:1595-1604. [PMID: 37579262 DOI: 10.1513/annalsats.202302-168oc] [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] [Received: 02/21/2023] [Accepted: 08/14/2023] [Indexed: 08/16/2023] Open
Abstract
Rationale: Magnetic resonance imaging (MRI) detects improvements in mucus plugging and bronchial wall thickening, but not in lung perfusion in patients with cystic fibrosis (CF) treated with elexacaftor/tezacaftor/ivacaftor (ETI). Objectives: To determine whether bronchial artery dilatation (BAD), a key feature of advanced lung disease, indicates irreversibility of perfusion abnormalities and whether BAD could be reversed in CF patients treated with ETI. Methods: A total of 59 adults with CF underwent longitudinal chest MRI, including magnetic resonance angiography twice, comprising 35 patients with CF (mean age, 31 ± 7 yr) before (MRI1) and after (MRI2) at least 1 month (mean duration, 8 ± 4 mo) on ETI therapy and 24 control patients with CF (mean age, 31 ± 7 yr) without ETI. MRI was assessed using the validated chest MRI score, and the presence and total lumen area of BAD were assessed with commercial software. Results: The MRI global score was stable in the control group from MRI1 to MRI2 (mean difference, 1.1 [-0.3, 2.4]; P = 0.054), but it was reduced in the ETI group (-10.1 [-0.3, 2.4]; P < 0.001). In the control and ETI groups, BAD was present in almost all patients at baseline (95% and 94%, respectively), which did not change at MRI2. The BAD total lumen area did not change in the control group from MRI1 to MRI2 (1.0 mm2 [-0.2, 2.2]; P = 0.099) but decreased in the ETI group (-7.0 mm2 [-8.9, -5.0]; P < 0.001). This decrease correlated with improvements in the MRI global score (r = 0.540; P < 0.001). Conclusions: Our data show that BAD may be partially reversible under ETI therapy in adult patients with CF who have established disease.
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Affiliation(s)
- Lena Wucherpfennig
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Simon M F Triphan
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Sabine Wege
- Department of Pulmonology and Respiratory Medicine, Cystic Fibrosis Center, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Claus P Heussel
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Translational Pulmonology and
| | - Mirjam Stahl
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Translational Pulmonology and
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research, Berlin, Germany; and
- Berlin Institute of Health at Charité - University Medicine Berlin, Berlin, Germany
| | - Marcus A Mall
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Translational Pulmonology and
- Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, University of Heidelberg, Heidelberg, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research, Berlin, Germany; and
- Berlin Institute of Health at Charité - University Medicine Berlin, Berlin, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, and
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
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10
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Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disease caused by variants in the gene encoding for the cystic fibrosis transmembrane conductance regulator (CFTR) protein. CFTR dysfunction results in abnormal chloride and bicarbonate transport in epithelial cells, leading to a multiorgan disease dominated by respiratory and digestive manifestations. The respiratory disease, which is characterized by airway mucus plugging, chronic bacterial infection and progressive development of bronchiectasis, may lead to chronic respiratory failure, which is the main cause of premature death in people with CF. Over the past 50 years, major progress has been obtained by implementing multidisciplinary care, including nutritional support, airway clearance techniques and antibiotics in specialized CF centers. The past 10 years have further seen the progressive development of oral medications, called CFTR modulators, that partially restore ion transport and lead to a major improvement in clinical manifestations and lung function, presumably resulting in longer survival. Although an increasing proportion of people with CF are being treated with CFTR modulators, challenges remain regarding access to CFTR modulators due to their high cost, and their lack of marketing approval and/or effectiveness in people with rare CFTR variants. The anticipated increase in the number of adults with CF and their aging also challenge the current organization of CF care. The purpose of this review article is to describe current status and future perspective of CF disease and care.
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Affiliation(s)
- Isabelle Fajac
- Department of Respiratory Medicine and National Cystic Fibrosis Reference Centre, Cochin Hospital, Assistance Publique Hôpitaux de Paris, 27 rue du faubourg Saint-Jacques, 75014 Paris, France; Université Paris Cité, Inserm U1016, Institut Cochin, 24 rue du faubourg Saint-Jacques, 75014 Paris, France; ERN-LUNG, CF Core Network, Frankfurt, Germany.
| | - Pierre-Régis Burgel
- Department of Respiratory Medicine and National Cystic Fibrosis Reference Centre, Cochin Hospital, Assistance Publique Hôpitaux de Paris, 27 rue du faubourg Saint-Jacques, 75014 Paris, France; Université Paris Cité, Inserm U1016, Institut Cochin, 24 rue du faubourg Saint-Jacques, 75014 Paris, France; ERN-LUNG, CF Core Network, Frankfurt, Germany.
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11
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Gifford AH, Hinton AC, Jia S, Nasr SZ, Mermis JD, Lahiri T, Zemanick ET, Teneback CC, Flume PA, DiMango EA, Sadeghi H, Polineni D, Dezube RH, West NE, Dasenbrook EC, Lucas FL, Zuckerman JB. Complications and Practice Variation in the Use of Peripherally Inserted Central Venous Catheters in People With Cystic Fibrosis: The Prospective Study of Peripherally Inserted Venous Catheters in People With Cystic Fibrosis Study. Chest 2023; 164:614-624. [PMID: 37019356 PMCID: PMC10504599 DOI: 10.1016/j.chest.2023.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are used commonly to administer antibiotics to people with cystic fibrosis (CF), but their use can be complicated by venous thrombosis and catheter occlusion. RESEARCH QUESTION Which participant-, catheter-, and catheter management-level attributes are associated with increased risk of complications of PICCs among people with CF? STUDY DESIGN AND METHODS This was a prospective observational study of adults and children with CF who received PICCs at 10 CF care centers in the United States. The primary end point was defined as occlusion of the catheter resulting in unplanned removal, symptomatic venous thrombosis in the extremity containing the catheter, or both. Three categories of composite secondary outcomes were identified: difficult line placement, local soft tissue or skin reactions, and catheter malfunction. Data specific to the participant, catheter placement, and catheter management were collected in a centralized database. Risk factors for primary and secondary outcomes were analyzed by multivariate logistic regression. RESULTS Between June 2018 and July 2021, 157 adults and 103 children older than 6 years with CF had 375 PICCs placed. Patients underwent 4,828 catheter-days of observation. Of the 375 PICCs, 334 (89%) were ≤ 4.5 F, 342 (91%) were single lumen, and 366 (98%) were placed using ultrasound guidance. The primary outcome occurred in 15 PICCs for an event rate of 3.11 per 1,000 catheter-days. No cases of catheter-related bloodstream infection occurred. Other secondary outcomes developed in 147 of 375 catheters (39%). Despite evidence of practice variation, no risk factors for the primary outcome and few risk factors for secondary outcomes were identified. INTERPRETATION This study affirmed the safety of contemporary approaches to inserting and using PICCs in people with CF. Given the low rate of complications in this study, observations may reflect a widespread shift to selecting smaller-diameter PICCs and using ultrasound to guide their placement.
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Affiliation(s)
- Alex H Gifford
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Pulmonology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | - Shijing Jia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Samya Z Nasr
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Joel D Mermis
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Kansas Health System, Kansas City, KS
| | - Thomas Lahiri
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Vermont Children's Hospital, Division of Pulmonary Disease & Critical Care Medicine, Department of Medicine, the University of Vermont Medical Center, Burlington, VT
| | - Edith T Zemanick
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Charlotte C Teneback
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Vermont Children's Hospital, Division of Pulmonary Disease & Critical Care Medicine, Department of Medicine, the University of Vermont Medical Center, Burlington, VT
| | - Patrick A Flume
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Emily A DiMango
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and the Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Hossein Sadeghi
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Deepika Polineni
- Division of Pulmonary, Critical Care and Sleep Medicine, Washington University at St. Louis, St. Louis, MO
| | - Rebecca H Dezube
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
| | - Natalie E West
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
| | | | - F Lee Lucas
- Maine Medical Center Research Institute, Scarborough, ME
| | - Jonathan B Zuckerman
- Maine Medical Center Research Institute, Scarborough, ME; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Maine Medical Center, Portland, ME.
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12
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Flume PA, Basavaraj A, Garcia B, Winthrop K, Di Mango E, Daley CL, Philley JV, Henkle E, O'Donnell AE, Metersky M. Towards development of evidence to inform recommendations for the evaluation and management of bronchiectasis. Respir Med 2023; 211:107217. [PMID: 36931575 DOI: 10.1016/j.rmed.2023.107217] [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: 09/22/2022] [Revised: 02/17/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Bronchiectasis (BE) is a chronic condition characterized by airway dilation as a consequence of a variety of pathogenic processes. It is often associated with persistent airway infection and an inflammatory response resulting in cough productive of purulent sputum, which has an adverse impact on quality of life. The prevalence of BE is increasing worldwide. Treatment guidelines exist for managing BE, but they are generally informed by a paucity of high-quality evidence. This review presents the findings of a scientific advisory board of experts held in the United States in November 2020. The main focus of the meeting was to identify unmet needs in BE and propose ways to identify research priorities for the management of BE, with a view to developing evidence-based treatment recommendations. Key issues identified include diagnosis, patient evaluation, promoting airway clearance and appropriate use of antimicrobials. Unmet needs include effective pharmacological agents to promote airway clearance and reduce inflammation, control of chronic infection, clinical endpoints to be used in the design of BE clinical trials, and more accurate classification of patients using phenotypes and endotypes to better guide treatment decisions and improve outcomes.
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Affiliation(s)
- Patrick A Flume
- Department of Medicine and Pediatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Room 816-CSB, Charleston, SC, USA.
| | - Ashwin Basavaraj
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue, Administration Building OBV, A601, New York, NY, 10016, USA.
| | - Bryan Garcia
- University of Alabama at Birmingham, 1900 University Blvd, THT Suite 541A, Birmingham, AL, 35233, USA.
| | - Kevin Winthrop
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, 97239, Portland, OR, USA.
| | - Emily Di Mango
- Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| | - Charles L Daley
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Julie V Philley
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center at Tyler, 11937 US Hwy 271, 75708, Tyler, USA.
| | - Emily Henkle
- Oregon Health and Science University, OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd, Mailcode VPT, Portland, OR, 97239, USA.
| | - Anne E O'Donnell
- Division of Pulmonary, Critical Care and Sleep Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | - Mark Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030-1321, USA.
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13
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Bayomy OF, Ramos KJ, Hee Wai T, Kapnadak SG, Morrell ED, Nomitch JT, Pollack LR, Lease ED, Aitken ML, Stephenson AL, Goss CH. Hemoptysis and the Risk for Lung Transplant or Death without Transplant in Individuals with Cystic Fibrosis in the United States. Ann Am Thorac Soc 2022; 19:1986-1992. [PMID: 35759341 PMCID: PMC9743473 DOI: 10.1513/annalsats.202202-110oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale: Hemoptysis is a common and important complication in persons with cystic fibrosis (PwCF). Despite this, there is limited literature on the impact of hemoptysis on contemporary cystic fibrosis (CF) outcomes. Objectives: Evaluate whether hemoptysis increases the risk of lung transplant or death without a transplant in PwCF. Methods: We reviewed a dataset of PwCF ages 12 years or older from the CFFPR (CF Foundation Patient Registry) that included 29,587 individuals. We identified hemoptysis as our predictor of interest and categorized PwCF as either no hemoptysis, any hemoptysis (submassive and/or massive), or massive hemoptysis. We subsequently evaluated whether hemoptysis, as defined above, was associated with death without transplant or receipt of lung transplant via logistic regression. We adjusted for age, sex, body mass index, forced expiratory volume in one second (FEV1), number of exacerbations, supplemental oxygen use, CF-related diabetes, and Pseudomonas aeruginosa colonization status. Subgroup analyses were performed in advanced lung disease, defined as PwCF with an FEV1 <40% predicted. Results: PwCF with any form of hemoptysis were more likely to progress to lung transplant or die without transplant than PwCF who did not have hemoptysis (odds ratio [OR], 1.3 [95% confidence interval (CI), 1.1-1.7]). The effect size of these associations was larger when hemoptysis events were classified as "massive" (massive hemoptysis OR, 2.2 [95% CI, 1.2-3.8]) or in PwCF with advanced lung disease (massive hemoptysis in advanced lung disease OR, 3.2 [95% CI 1.3-8.2]). Conclusions: Hemoptysis is associated with an increased risk of lung transplant and death without a transplant in PwCF, especially among those with massive hemoptysis or advanced lung disease. Our results suggest that hemoptysis functions as a useful predictor of serious outcomes in PwCF and may be important to incorporate into risk prediction models and/or transplant decisions in CF.
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Affiliation(s)
- Omar F. Bayomy
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Kathleen J. Ramos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Travis Hee Wai
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | | | - Eric D. Morrell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Jamie T. Nomitch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Lauren R. Pollack
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Erika D. Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Moira L. Aitken
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Anne L. Stephenson
- Division of Respirology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Christopher H. Goss
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
- Division of Pulmonary Medicine, Department of Pediatrics, University of Washington, Seattle, Washington; and
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14
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Dohna M, Kühl H, Sutharsan S, Dohna-Schwake C, Vo Chieu VD, Hellms S, Kornemann N, Renz DM, Montag MJ. Bronchial artery diameter in massive hemoptysis in cystic fibrosis. BMC Pulm Med 2022; 22:424. [PMID: 36397043 PMCID: PMC9670530 DOI: 10.1186/s12890-022-02233-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Massive hemoptysis is a rare but potentially life-threatening condition of patients with cystic fibrosis (CF) and advanced pulmonary disease. Hypertrophied bronchial arteries are understood to cause massive hemoptysis when rupturing. Risk factors to predict massive hemoptysis are scarce and bronchial artery diameters are not part of any scoring system in follow-up of patients with CF. Aim of this study was to correlate bronchial artery diameter with massive hemoptysis in CF. Methods Bronchial artery and non-bronchial systemic artery diameters were measured in contrast enhanced computed tomography (CT) scans in patients with massive hemoptysis and compared to patients with end-stage CF and no history of hemoptysis. Demographic and clinical data and side of bronchial artery/non-bronchial systemic artery hypertrophy and coil embolization were documented. Results In this retrospective multicenter study 33 patients with massive hemoptysis were included for bronchial artery/non-bronchial systemic artery diameter measurements, (13 female, 20 male, median age 30 years (18–55)). Bronchial artery diameters were significantly larger in the case group than in the control group with median 4 mm (2.2–8.2 mm), and median 3 mm (1–7 mm), respectively (p = 0.002). Sensitivity of bronchial arteries ≥ 3.5 mm to be associated with hemoptysis was 0.76 and specificity 0.71 with ROC creating an area under the curve of 0.719. If non-bronchial systemic arteries were present, they were considered culprit and embolized in 92% of cases. Conclusion Bronchial arteries ≥ 3.5 mm and presence of hypertrophied non-bronchial systemic arteries correlate with massive hemoptysis in patients with CF and might serve as risk predictor for massive hemoptysis. Therefore, in patients with advanced CF we propose CT scans to be carried out as CT angiography to search for bronchial arteries ≥ 3.5 mm and for hypertrophied non-bronchial systemic arteries as possible risk factors for massive hemoptysis.
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15
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Sheppard M, Selvadurai H, Robinson PD, Pandit C, Chennapragada SM, Fitzgerald DA. Approaches to the management of haemoptysis in young people with cystic fibrosis. Paediatr Respir Rev 2022:S1526-0542(22)00070-7. [PMID: 36463090 DOI: 10.1016/j.prrv.2022.10.002] [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: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Haemoptysis occurs in up to 25 % of young people with Cystic fibrosis (CF) [1]. We undertook a literature review and described the management approach to haemoptysis in CF between 2010 and 2020 at an Australian tertiary paediatric centre, The Children's Hospital Westmead, Sydney, New South Wales, using a retrospective review of the medical records which identified 67 episodes. Sixty episodes met inclusion criteria, including 31 patients. Using the US CF Foundation guidelines, episodes were classified as scant (53.3 %), moderate (38.3 %) or massive (8.3 %). Fifty-two percent of patients were female, mean age at presentation was 15.4 years (SD+/- 2.4) and 58 % were homozygous for the Fdel508 genotype. Twelve episodes (9 patients) required bronchial artery embolization (BAE). BAE was used in all cases of massive haemoptysis 5/5 (100 %), 6/23 (22 %) episodes of moderate and 1/32 (3 %) episode of scant haemoptysis as an elective procedure for recurrent haemoptysis. Our literature review and institutional experience highlights the need for up-to-date management guidelines in the management of haemoptysis in Cystic Fibrosis. Based on our experience, we provide a proposed algorithm to help guide the management of haemoptysis in CF.
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Affiliation(s)
- Megan Sheppard
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia.
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - S Murthy Chennapragada
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, NSW, Australia; Department of Medical Imaging (Interventional Radiology), The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, NSW, Australia
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16
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Acute Emergency Management of Pulmonary Hemorrhage in Children: Rare But Scary. Pediatr Emerg Care 2022; 38:e1664-e1666. [PMID: 35947055 DOI: 10.1097/pec.0000000000002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Quinn AM, Bottery MJ, Thompson H, Friman VP. Resistance evolution can disrupt antibiotic exposure protection through competitive exclusion of the protective species. THE ISME JOURNAL 2022; 16:2433-2447. [PMID: 35859161 PMCID: PMC9477885 DOI: 10.1038/s41396-022-01285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 12/05/2022]
Abstract
Antibiotic degrading bacteria can reduce the efficacy of drug treatments by providing antibiotic exposure protection to pathogens. While this has been demonstrated at the ecological timescale, it is unclear how exposure protection might alter and be affected by pathogen antibiotic resistance evolution. Here, we utilised a two-species model cystic fibrosis (CF) community where we evolved the bacterial pathogen Pseudomonas aeruginosa in a range of imipenem concentrations in the absence or presence of Stenotrophomonas maltophilia, which can detoxify the environment by hydrolysing β-lactam antibiotics. We found that P. aeruginosa quickly evolved resistance to imipenem via parallel loss of function mutations in the oprD porin gene. While the level of resistance did not differ between mono- and co-culture treatments, the presence of S. maltophilia increased the rate of imipenem resistance evolution in the four μg/ml imipenem concentration. Unexpectedly, imipenem resistance evolution coincided with the extinction of S. maltophilia due to increased production of pyocyanin, which was cytotoxic to S. maltophilia. Together, our results show that pathogen resistance evolution can disrupt antibiotic exposure protection due to competitive exclusion of the protective species. Such eco-evolutionary feedbacks may help explain changes in the relative abundance of bacterial species within CF communities despite intrinsic resistance to anti-pseudomonal drugs.
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18
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Ciuca IM, Dediu M, Popin D, Pop LL, Tamas LA, Pilut CN, Almajan Guta B, Popa ZL. Antibiotherapy in Children with Cystic Fibrosis—An Extensive Review. CHILDREN 2022; 9:children9081258. [PMID: 36010149 PMCID: PMC9406924 DOI: 10.3390/children9081258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022]
Abstract
In cystic fibrosis (CF), the respiratory disease is the main factor that influences the outcome and the prognosis of patients, bacterial infections being responsible for severe exacerbations. The etiology is often multi-microbial and with resistant strains. The aim of this paper is to present current existing antibiotherapy solutions for CF-associated infections in order to offer a reliable support for individual, targeted, and specific treatment. The inclusion criteria were studies about antibiotherapy in CF pediatric patients. Studies involving adult patients or those with only in vitro results were excluded. The information sources were all articles published until December 2021, in PubMed and ScienceDirect. A total of 74 studies were included, with a total number of 26,979 patients aged between 0–18 years. We approached each pathogen individual, with their specific treatment, comparing treatment solutions proposed by different studies. Preservation of lung function is the main goal of therapy in CF, because once parenchyma is lost, it cannot be recovered. Early personalized intervention and prevention of infection with reputable germs is of paramount importance, even if is an asymmetrical challenge. This research received no external funding.
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Affiliation(s)
- Ioana Mihaiela Ciuca
- Pediatric Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
- Pediatric Pulmonology Unit, Clinical County Hospital Timisoara, Evlia Celebi 1-3, 300226 Timisoara, Romania
| | - Mihaela Dediu
- Pediatric Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Diana Popin
- Pediatric Pulmonology Unit, Clinical County Hospital Timisoara, Evlia Celebi 1-3, 300226 Timisoara, Romania
| | - Liviu Laurentiu Pop
- Pediatric Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Liviu Athos Tamas
- Biochemistry Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-744-764737
| | - Ciprian Nicolae Pilut
- Microbiology Department, University of Medicine and Pharmacy “Victor Babes” Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Bogdan Almajan Guta
- Kinesiotherapy and Special Motricity Department, West University of Timisoara, 4 Vasile Parvan bld., 300223 Timisoara, Romania
| | - Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Victor Babes” Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
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19
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Scanio MJC, Searle XB, Liu B, Koenig JR, Altenbach RJ, Gfesser GA, Bogdan A, Greszler S, Zhao G, Singh A, Fan Y, Swensen AM, Vortherms T, Manelli A, Balut C, Gao W, Yong H, Schrimpf M, Tse C, Kym P, Wang X. Discovery and SAR of 4-aminopyrrolidine-2-carboxylic acid correctors of CFTR for the treatment of cystic fibrosis. Bioorg Med Chem Lett 2022; 72:128843. [PMID: 35688367 DOI: 10.1016/j.bmcl.2022.128843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
Cystic fibrosis (CF) is an autosomal recessive disease resulting from mutations on both copies of the CFTR gene. Phenylalanine deletion at position 508 of the CFTR protein (F508del-CFTR) is the most frequent mutation in CF patients. Currently, the most effective treatments of CF use a dual or triple combination of CFTR correctors and potentiators. In triple therapy, two correctors (C1 and C2) and a potentiator are employed. Herein, we describe the identification and exploration of the SAR of a series of 4-aminopyrrolidine-2-carboxylic acid C2 correctors of CFTR to be used in conjunction with our existing C1 corrector series for the treatment of CF.
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Affiliation(s)
- Marc J C Scanio
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States.
| | - Xenia B Searle
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Bo Liu
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - John R Koenig
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Robert J Altenbach
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Gregory A Gfesser
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Andrew Bogdan
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Stephen Greszler
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Gang Zhao
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Ashvani Singh
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Yihong Fan
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Andrew M Swensen
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Timothy Vortherms
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Arlene Manelli
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Corina Balut
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Wenqing Gao
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Hong Yong
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Michael Schrimpf
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Chris Tse
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Philip Kym
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
| | - Xueqing Wang
- Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, United States
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20
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Israeli T, Eisenstadt I, Shoseyov D, Armoni S, Gileles-Hillel A, Cremisi G, Cohen-Cymberknoh M, Breuer O. Respiratory physiotherapy in patients with cystic fibrosis and upper limb deep vein thrombosis. Pediatr Pulmonol 2022; 57:1552-1554. [PMID: 35322603 DOI: 10.1002/ppul.25903] [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: 12/24/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Abstract
We report physiotherapy management of two patients with severe cystic fibrosis (CF) lung disease and upper limb deep vein thrombosis (DVT). These patients were admitted due to a pulmonary exacerbation. Following peripherally inserted central catheters, they were diagnosed with an upper limb DVT. Due to their underlying lung disease, physiotherapy was mandatory for improvement. However, the DVT and anticoagulation treatment raised concerns for pulmonary emboli and hemoptysis. A framework for physiotherapy management in these patients, using a set of precautions and restrictions to maintain airway clearance while minimizing the risk for pulmonary emboli and hemoptysis, was established. Using this set of instructions, the patients experienced no major adverse events while maintaining sufficient airway clearance to allow respiratory improvement. These precautions were continued until the upper limb DVTs were resolved. To our knowledge, there are currently no guidelines or expert opinions available. Therefore, this framework can help guide physiotherapy management.
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Affiliation(s)
- Tomer Israeli
- Department of Physiotherapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Iris Eisenstadt
- Department of Physiotherapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Shoseyov
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shoshana Armoni
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alex Gileles-Hillel
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Cremisi
- Department of Physiotherapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Oded Breuer
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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21
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Angiographic and histopathological study on bronchial-to-pulmonary vascular anastomoses on explants from patients with cystic fibrosis after bronchial artery embolisation. J Cyst Fibros 2022; 21:1042-1047. [DOI: 10.1016/j.jcf.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
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22
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Duman I, Ünal G, Yilmaz AI, Güney AY, Durduran Y, Pekcan S. Inhaled Dry Powder Mannitol Treatment in Pediatric Patients with Cystic Fibrosis: Evaluation of Clinical Data in a Real-World Setting. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:19-26. [PMID: 35285672 DOI: 10.1089/ped.2021.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Cystic fibrosis (CF) is a genetic disorder, in which defective clearance of airway secretions leads to progressive lung function loss. Inhaled mannitol is used to increase sputum and mucociliary clearance. There are little data from real-world studies on the effectiveness of mannitol in children. Our objective was to evaluate the spirometry and clinical results of mannitol in pediatric patients. Methods: We retrospectively reviewed the records of 30 children and adolescents with CF receiving inhaled mannitol who were already on recombinant human deoxyribonuclease (rhDNase) treatment. The change in forced expiratory volume in 1 second (FEV1) from baseline at 2-4 months was the primary outcome. Secondary measures were other spirometry results, body mass index (BMI), hospital admissions, sputum characteristics, and positive bacterial colonization. Results: Compared to baseline, we found significant improvement in percent predicted FEV1 at 2-4 months of treatment; 84.50 (58.00-99.00) vs. 96.00 (66.00-106.00) (P = 0.0007). The absolute change in FEV1 was +11.5% at 2-4 months, +6.5% at 5-7 months, and +4% at 8-12 months. Also, significant improvements in other spirometry results were observed. Adolescents had significantly lower FEV1 results, but the improvement in their lung function was sustained for a more extended period than children. Mannitol provided easier sputum removal, increased sputum volume, significant decline in hospitalizations, and significantly fewer patients with positive sputum cultures. A significant increase in BMI at 8-12 months was observed. Cough was the most frequent adverse effect. Conclusion: In a real-world setting, our results demonstrated that adding mannitol to rhDNase therapy is tolerable in pediatric patients with CF and may provide improved spirometry and clinical outcomes. In addition, our results showed that mannitol provided recovery in overall lung function at 2-4 months, which was sustained up to 12 months together with improved BMI, easier sputum removal, and a decline in bacterial colonization and hospital admissions. However, cough was the most frequent side effect.
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Affiliation(s)
- Ipek Duman
- Department of Medical Pharmacology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Gokcen Ünal
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Asli Imran Yilmaz
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Yasin Güney
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yasemin Durduran
- Department of Public Health, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, and Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
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23
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Ramsey ML, Wellner MR, Porter K, Kirkby SE, Li SS, Lara LF, Kelly SG, Hanje AJ, Sobotka LA. Cystic fibrosis patients on cystic fibrosis transmembrane conductance regulator modulators have a reduced incidence of cirrhosis. World J Hepatol 2022; 14:411-419. [PMID: 35317183 PMCID: PMC8891668 DOI: 10.4254/wjh.v14.i2.411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/15/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators significantly improve pulmonary function in patients with cystic fibrosis (CF) but the effect on hepatobiliary outcomes remains unknown. We hypothesized that CF patients on CFTR modulators would have a decreased incidence of cirrhosis compared to patients not on CFTR modulators or on ursodiol.
AIM To investigate the effect of CFTR modulators on the development of cirrhosis in patients with CF.
METHODS A retrospective analysis was performed using Truven MarketScan from January 2012 through December 2017 including all patients with a diagnosis of CF. Patients were excluded if they underwent a liver transplantation or if they had other etiologies of liver disease including viral hepatitis or alcohol use. Subjects were grouped by use of CFTR modulators, ursodiol, dual therapy, or no therapy. The primary outcome was development of cirrhosis. Kaplan-Meier curves estimated the incidence of cirrhosis and log-rank tests compared incidence curves between treatment groups.
RESULTS A total of 7201 patients were included, of which 955 (12.6%) used a CFTR modulator, 529 (7.0%) used ursodiol, 105 (1.4%) used combination therapy, and 5612 (74.3%) used neither therapy. The incidence of cirrhosis was 0.1% at 1 year and 0.7% at 4 years in untreated patients, 5.9% and 10.1% in the Ursodiol group, and 1.0% and 1.0% in patients who received both therapies. No patient treated with CFTR modulators alone developed cirrhosis. Patients on CFTR modulators alone had lower cirrhosis incidence than untreated patients (P = 0.05), patients on Ursodiol (P < 0.001), and patients on dual therapy (P = 0.003). The highest incidence of cirrhosis was found among patients treated with Ursodiol alone, compared to untreated patients (P < 0.001) or patients on Ursodiol and CFTR modulators (P = 0.01).
CONCLUSION CFTR modulators are associated with a reduction in the incidence of cirrhosis compared to other therapies in patients with CF.
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Affiliation(s)
- Mitchell L Ramsey
- Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Michael R Wellner
- Department of Gastroenterology, Hepatology and Nutrition, The Ohio State Wexner Medical Center, Columbus, OH 43210, United States
| | - Kyle Porter
- Department of Biostatistics, The Ohio State University, Columbus, OH 43210, United States
| | - Stephen E Kirkby
- Department of Pulmonary and Critical Care Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Susan S Li
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Luis F Lara
- Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH 43210, United States
| | - Sean G Kelly
- Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - A James Hanje
- Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Lindsay A Sobotka
- Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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24
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McBennett KA, Davis PB, Konstan MW. Increasing life expectancy in cystic fibrosis: Advances and challenges. Pediatr Pulmonol 2022; 57 Suppl 1:S5-S12. [PMID: 34672432 PMCID: PMC9004282 DOI: 10.1002/ppul.25733] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 01/14/2023]
Abstract
Since the first description of cystic fibrosis in 1938, there have been significant advances in both quality of life and longevity for people living with this disease. In this article we describe the milestones of the last 80 years and what we perceive to be the remaining barriers to normalcy for this population.
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Affiliation(s)
- Kimberly A McBennett
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Pamela B Davis
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael W Konstan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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25
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West NE, Kazmerski TM, Taylor-Cousar JL, Tangpricha V, Pearson K, Aitken ML, Jain R. Optimizing sexual and reproductive health across the lifespan in people with cystic fibrosis. Pediatr Pulmonol 2022; 57 Suppl 1:S89-S100. [PMID: 34570960 PMCID: PMC9291766 DOI: 10.1002/ppul.25703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
With improved therapies, people with cystic fibrosis are living longer and healthier lives and increasingly have questions surrounding their sexual and reproductive health. This article will summarize the important issues of which providers should be aware during the lifespan of people with cystic fibrosis, including puberty, adulthood, and menopause. A wide range of sexual and reproductive health topics are addressed such as puberty, transgender and gender nonbinary identities, contraception, sexually transmitted infections, hypogonadism, sexual functioning, cyclical hemoptysis, and urinary incontinence. We discuss gaps in knowledge and current evidence as well as management strategies to optimize care. Our goal is to support providers to enable them to give comprehensive care throughout the lifespan of people with cystic fibrosis.
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Affiliation(s)
- Natalie E West
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Vin Tangpricha
- Department of Medicine, Division of Endocrinology, Metabolism & Lipids, Emory University, Atlanta, Georgia, USA
| | - Kelsie Pearson
- Cystic Fibrosis Foundation Therapeutics Development Network, Seattle Children's Hospital, Seattle, Washington, USA
| | - Moira L Aitken
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Raksha Jain
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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26
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Zsiborás C, Adonyi M, Stankovics J, Farkas A, Vajda P, Rózsai B. Severe Spontaneous Pneumomediastinum in a Girl with Cystic Fibrosis. European J Pediatr Surg Rep 2021; 9:e65-e67. [PMID: 34616649 PMCID: PMC8486495 DOI: 10.1055/s-0041-1731274] [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: 01/24/2021] [Accepted: 05/01/2021] [Indexed: 10/31/2022] Open
Abstract
We report on an 11-year-old girl with cystic fibrosis who presented with thoracic pain and an extensive subcutaneous emphysema and subsequently developed progressive respiratory distress. The chest computed tomography revealed a huge pneumomediastinum. Due to the development of severe respiratory failure, urgent needle thoracocentesis was necessary that resulted in only temporary improvement. Therefore, under general anesthesia two mediastinal drains were introduced. Using active suction, the size of the pneumomediastinum decreased gradually and the drains were removed after 3 weeks. Here, we describe an extremely rare situation, when acute surgical intervention was necessary in a child with spontaneous pneumomediastinum.
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Affiliation(s)
- Csaba Zsiborás
- Department of Pediatrics, University of Pécs, Medical School, Pecs, Hungary
| | - Mária Adonyi
- Department of Pediatrics, University of Pécs, Medical School, Pecs, Hungary
| | - József Stankovics
- Department of Pediatrics, University of Pécs, Medical School, Pecs, Hungary
| | - András Farkas
- Department of Pediatrics, University of Pécs, Medical School, Pecs, Hungary
| | - Peter Vajda
- Department of Pediatrics, University of Pécs, Medical School, Pecs, Hungary
| | - Barnabás Rózsai
- Department of Pediatrics, University of Pécs, Medical School, Pecs, Hungary
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27
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Ratjen F, VanDevanter DR. Retracing changes in cystic fibrosis understanding and management over the past twenty years. J Cyst Fibros 2021; 21:3-9. [PMID: 34602342 DOI: 10.1016/j.jcf.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Felix Ratjen
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Canada
| | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH USA.
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28
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Mori Y, Yamano Y, Kataoka K, Yokoyama T, Matsuda T, Kimura T, Ogawa T, Watanabe F, Kondoh Y. Pulmonary rehabilitation for idiopathic pleuroparenchymal fibroelastosis: A retrospective study on its efficacy, feasibility, and safety. Respir Investig 2021; 59:849-858. [PMID: 34561207 DOI: 10.1016/j.resinv.2021.08.003] [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] [Received: 05/13/2021] [Revised: 07/23/2021] [Accepted: 08/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The beneficial effects of pulmonary rehabilitation (PR) for patients with idiopathic pleuroparenchymal fibroelastosis (IPPFE) remain unknown. This study aimed to examine the efficacy, feasibility, and safety of PR for IPPFE. METHODS We retrospectively investigated 25 patients with IPPFE referred for PR between April 2007 and March 2017. The PR mainly consisted of a 10-week exercise training program. The primary outcome was a change in 6-min walk distance (6MWD). Secondary outcomes included changes in dyspnea (transition dyspnea index [TDI]), anxiety and depression (hospital anxiety and depression scale [HADS]), and health-related quality of life (HRQoL) (St George's respiratory questionnaire [SGRQ]). RESULTS Thirteen patients participated in the PR program (PRP). Recurrent pneumothorax was the most common reason for patients not participating in the PRP. Four patients discontinued the PRP due to the recurrence of pneumothorax, new onset of pneumomediastinum, stroke, and another reason, respectively. Nine patients completed the PRP. Significant improvement was observed in 6MWD (median [interquartile range], 90 m [55-116 m]; P = 0.033). Clinically important improvements in the 6MWD, and TDI, HADS-anxiety, HADS-depression, and SGRQ total domain scores were observed in seven (78%), five (56%), four (44%), four (44%), and five (56%) of the nine patients, respectively. CONCLUSIONS Patients with IPPFE benefited from PR in terms of exercise capacity, dyspnea, anxiety, depression, and HRQoL. Pneumothorax and pneumomediastinum may impede the implementation of a PRP for patients with IPPFE. While careful patient selection is required, PR may be an efficacious non-pharmacological approach for managing disabilities in patients with IPPFE.
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Affiliation(s)
- Yuta Mori
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan; Department of Respiratory Medicine, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Tomoya Ogawa
- Department of Rehabilitation, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Fumiko Watanabe
- Department of Rehabilitation, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
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29
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Semasinghe Bandaralage SP, Tay G, Hay K, Megram E, Smith D, Gadowski T, Wright E, France M, Bell S, Reid D. Outcomes of artery embolisation for cystic fibrosis patients with haemoptysis: a 20-year experience at a major Australian tertiary centre. Intern Med J 2021; 51:1526-1529. [PMID: 34541776 DOI: 10.1111/imj.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
There are no published data on Australian adult cystic fibrosis (CF) patient outcomes post bronchial arterial embolisation (BAE). We report 20 years of experience of BAE at a major Australian tertiary adult CF centre, where 46 patients underwent 100 BAE during this period. Mortality rate was comparable to previous studies (4% per year) and most who died had repeat BAE requirements. A higher proportion (9 out of 45) of patients were transplanted compared to previous publications. Repeat BAE was common and significantly higher in patients already on tranexamic acid.
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Affiliation(s)
- Sahan P Semasinghe Bandaralage
- Respiratory Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - George Tay
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Emma Megram
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Daniel Smith
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Tahlia Gadowski
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Eimear Wright
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Megan France
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Scott Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Lung Bacteria Group, Child Health Research Centre - University of Queensland, Brisbane, Queensland, Australia
| | - David Reid
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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30
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Abstract
Women with cystic fibrosis (CF) face several unaddressed concerns related to their health. These areas of concern include explanations and guidance on a sex disparity in outcomes, timing of puberty, effects of contraception, prevalence of infertility and impact of pregnancy, and prevention of urinary incontinence and osteoporosis. These understudied topics leave women with numerous unanswered questions about how to manage sexual and reproductive health in the setting of CF. Because people with CF are living longer and healthier lives, there is an increasing awareness of these important aspects of care and multiple ongoing studies to address these understudied topics.
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31
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Silveira MAPD, Silveira PAPD, Beltrami FG, Scaffaro LA, Dalcin PDTR. Clinical outcomes of cystic fibrosis patients with hemoptysis treated with bronchial artery embolization. J Bras Pneumol 2021; 47:e20200557. [PMID: 34406223 PMCID: PMC8352766 DOI: 10.36416/1806-3756/e20200557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Massive hemoptysis is one of the most serious complications in patients with cystic fibrosis (CF). This study aimed to evaluate the hemoptysis-free period following bronchial and non-bronchial artery embolization (BAE/non-BAE) in CF patients and to investigate predictors of recurrent bleeding and mortality by any cause. METHODS This was a retrospective cohort study of CF patients ≥ 16 years of age undergoing BAE/non-BAE for hemoptysis between 2000 and 2017. RESULTS We analyzed 39 hemoptysis episodes treated with BAE/non-BAE in 17 CF patients. Hemoptysis recurrence rate was 56.4%. Of the sample as a whole, 3 (17.6%) were hemoptysis-free during the study period, 2 (11.8%) underwent lung transplantation, and 3 (17.6%) died. The median hemoptysis-free period was 17 months. The median hemoptysis-free period was longer in patients with chronic infection with Pseudomonas aeruginosa (31 months; 95% CI: 0.00-68.5) than in those without that type of infection (4 months; 95% CI: 1.8-6.2; p = 0.017). However, this association was considered weak, and its clinical significance was uncertain due to the small number of patients without that infection. CONCLUSIONS BAE appears to be effective in the treatment of hemoptysis in patients with CF.
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Affiliation(s)
- Marília Amaral Peixoto da Silveira
- . 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 - Porto Alegre (RS) Brasil
| | | | - Flávia Gabe Beltrami
- . 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 - Porto Alegre (RS) Brasil
| | - Leandro Armani Scaffaro
- . Serviço de Radiologia, Hospital de Clínicas de Porto Alegre - HCPA - Porto Alegre (RS) 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 - Porto Alegre (RS) Brasil
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Dohna M, Renz DM, Stehling F, Dohna-Schwake C, Sutharsan S, Neurohr C, Wirtz H, Eickmeier O, Grosse-Onnebrink J, Sauerbrey A, Soditt V, Poplawska K, Wacker F, Montag MJ. Coil embolisation for massive haemoptysis in cystic fibrosis. BMJ Open Respir Res 2021; 8:8/1/e000985. [PMID: 34385150 PMCID: PMC8362706 DOI: 10.1136/bmjresp-2021-000985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Massive haemoptysis is a life-threatening event in advanced cystic fibrosis (CF) lung disease with bronchial artery embolisation (BAE) as standard of care treatment. The aim of our study was to scrutinise short-term and long-term outcomes of patients with CF and haemoptysis after BAE using coils. Methods We carried out a retrospective cohort study of 34 adult patients treated for massive haemoptysis with super selective bronchial artery coil embolisation (ssBACE) between January 2008 and February 2015. Embolisation protocol was restricted to the culprit vessel(s) and three lobes maximum. Demographic data, functional end-expiratory volume in 1 s in % predicted (FEV1% pred.) and body mass index before and after ssBACE, sputum colonisation, procedural data, time to transplant and time to death were documented. Results Patients treated with ssBACE showed significant improvement of FEV1% pred. after embolisation (p=0.004) with 72.8% alive 5 years post-ssBACE. Mean age of the patients was 29.9 years (±7.7). Mean FEV1% pred. was 45.7% (±20.1). Median survival to follow-up was 75 months (0–125). Severe complication rate was 0%, recanalisation rate 8.8% and 5-year-reintervention rate 58.8%. Chronic infection with Pseudomonas aeruginosa was found in 79.4%, Staphylococcus areus in 50% and Aspergillus fumigatus in 47.1%. Discussion ssBACE is a safe and effective treatment for massive haemoptysis in patients with CF with good results for controlling haemostasis and excellent short-term and long-term survival, especially in severely affected patients with FEV<40% pred. We think the data of our study support the use of coils and a protocol of careful and prudent embolisation.
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Affiliation(s)
- Martha Dohna
- Pediatric Radiology, Hannover Medical School, Hannover, Germany
| | | | - Florian Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Claus Neurohr
- Robert-Bosch-Krankenhaus Klinik Schillerhohe, Gerlingen, Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Olaf Eickmeier
- Department of Pneumology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | | | - Volker Soditt
- Pediatrics, Stadtisches Klinikum Solingen, Solingen, Germany
| | - Krystyna Poplawska
- Pediatrics, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Frank Wacker
- Radiology, Hannover Medical School, Hannover, Germany
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Abstract
OBJECTIVES Hemoptysis is uncommon in children, even among the critically ill, with a paucity of epidemiological data to inform clinical decision-making. We describe hemoptysis-associated ICU admissions, including those who were critically ill at hemoptysis onset or who became critically ill as a result of hemoptysis, and identify predictors of mortality. DESIGN Retrospective cohort study. Demographics, hemoptysis location, and management were collected. Pediatric Logistic Organ Dysfunction-2 score within 24 hours of hemoptysis described illness severity. Primary outcome was inhospital mortality. SETTING Quaternary pediatric referral center between July 1, 2010, and June 30, 2017. PATIENTS Medical/surgical (PICU), cardiac ICU, and term neonatal ICU admissions with hemoptysis during or within 24 hours of ICU admission. INTERVENTIONS No intervention. MEASUREMENTS AND MAIN RESULTS There were 326 hemoptysis-associated ICU admissions in 300 patients. Most common diagnoses were cardiac (46%), infection (15%), bronchiectasis (10%), and neoplasm (7%). Demographics, interventions, and outcomes differed by diagnostic category. Overall, 79 patients (26%) died inhospital and 109 (36%) had died during follow-up (survivor mean 2.8 ± 1.9 yr). Neoplasm, bronchiectasis, renal dysfunction, inhospital hemoptysis onset, and higher Pediatric Logistic Organ Dysfunction-2 score were independent risk factors for inhospital mortality (p < 0.02). Pharmacotherapy (32%), blood products (29%), computerized tomography angiography (26%), bronchoscopy (44%), and cardiac catheterization (36%) were common. Targeted surgical interventions were rare. Of survivors, 15% were discharged with new respiratory support. Of the deaths, 93 (85%) occurred within 12 months of admission. For patients surviving 12 months, 5-year survival was 87% (95% CI, 78-92) and mortality risk remained only for those with neoplasm (log-rank p = 0.001). CONCLUSIONS We observed high inhospital mortality from hemoptysis-associated ICU admissions. Mortality was independently associated with hemoptysis onset location, underlying diagnosis, and severity of critical illness at event. Additional mortality was observed in the 12-month posthospital discharge. Future directions include further characterization of this vulnerable population and management recommendations for life-threatening pediatric hemoptysis incorporating underlying disease pathophysiology.
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Mingora CM, Flume PA. Pulmonary Complications in Cystic Fibrosis: Past, Present, and Future. Chest 2021; 160:1232-1240. [PMID: 34147501 DOI: 10.1016/j.chest.2021.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic condition with multisystemic disease manifestations, the most prominent of which occur in the respiratory system. Despite significant developments in disease understanding and therapeutics, each contributing to improved lung function and survival in patients with CF, several pulmonary complications, including pneumothorax, massive hemoptysis, and respiratory failure, continue to occur. In this review, we briefly describe each of these complications and their management and discuss how they impact the care and disease trajectory of individuals in whom they occur. Finally, we discuss the evolving role that palliative care and CF transmembrane conductance regular modulator therapies play in the natural disease course and care of patients with CF.
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Affiliation(s)
- Christina M Mingora
- Department of Medicine, Medical University of South Carolina, Charleston, SC.
| | - Patrick A Flume
- Department of Medicine, Medical University of South Carolina, Charleston, SC
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Bozkanat KM, West NE, Ladores S, Montemayor K, Tupayachi Ortiz MG, Christianson M, Jain R. Catamenial haemoptysis in females with cystic fibrosis: a case series with review of management strategies. Respirol Case Rep 2021; 9:e00755. [PMID: 33976884 PMCID: PMC8103099 DOI: 10.1002/rcr2.755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2023] Open
Abstract
Catamenial haemoptysis, the expectoration of blood during menses, has not been extensively reported in the cystic fibrosis (CF) literature. We describe four cases (age range: 25-34 years) of catamenial haemoptysis across four CF centres in the United States. These cases may represent thoracic endometriosis versus hormonal fluctuations in airway inflammation or infection resulting in bronchial artery bleeding. We identify common and nuanced management strategies including use of pro-coagulants, hormone contraceptives, anti-inflammatories, bronchial artery embolization, and use of the newer cystic fibrosis transmembrane conductance regulator (CFTR) modulators.
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Affiliation(s)
- Kubra M. Bozkanat
- Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Natalie E. West
- Department of Internal MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Sigrid Ladores
- School of NursingUniversity of Alabama at BirminghamBirminghamALUSA
| | | | | | - Mindy Christianson
- Department of Obstetrics and Gynecology, Internal MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Raksha Jain
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
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Gavioli EM, Pao K, Harrington M. A retrospective evaluation of vitamin K for hemoptysis in adult cystic fibrosis patients. Hosp Pract (1995) 2021; 49:262-265. [PMID: 33726579 DOI: 10.1080/21548331.2021.1905413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Hemoptysis is a complication in cystic fibrosis (CF) patients, and is associated with pulmonary exacerbations and hospitalizations. Pancreatic insufficiency is common in CF patients, and therefore these patients may benefit from the use of vitamin K therapy. METHODS This was an observational study conducted in adult CF patients aiming to describe the utilization of vitamin K therapy in the setting of hemoptysis during an acute CF pulmonary exacerbation. An evaluation of hospital length of stay, time until the next pulmonary exacerbation, and 30-day re-admission rates were evaluated in CF patients who presented with hemoptysis and received vitamin K therapy. RESULTS The average dose of vitamin K therapy was 10 mg for an average duration of 4.9 ± 0.55 days for 38 adult CF patients included in this cohort. The median length of stay among patients who received vitamin K therapy was 8 days (IQR: 6-12 days). The median time until next hospital admission was 127 days (95% CI: 71.4 to 182.6 days), and the 30-day readmission rates were 7.89%. Two patients developed a thromboembolism after receiving vitamin K therapy. CONCLUSIONS Evidence for the use of vitamin K therapy in the setting of CF-related hemoptysis remains unclear, and warrants further safety and efficacy evaluation. Further prospective studies are needed to determine the appropriateness of dosing and duration of vitamin K therapy, as well as determining its role in the setting of the varying levels of hemoptysis during a pulmonary CF exacerbation.
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Affiliation(s)
- Elizabeth Marie Gavioli
- Arnold and Marie Schwartz College of Pharmacy and Health Sciences, 1 University Plaza, Brooklyn, New York, United States.,Mount Sinai Beth Israel Hospital, New York, United States
| | - Kevin Pao
- Mount Sinai Beth Israel Hospital, New York, United States
| | - Matthew Harrington
- Mount Sinai Beth Israel Hospital, New York, United States.,Icahn School of Medicine at Mount Sinai, New York, United States
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Kalamara EI, Ballas ET, Pitsiou G, Petrova G. Pulmonary rehabilitation for cystic fibrosis: A narrative review of current literature. Monaldi Arch Chest Dis 2021; 91. [PMID: 33792230 DOI: 10.4081/monaldi.2021.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Pulmonary rehabilitation is a key component in cystic fibrosis care. This review summarizes the recent evidence in the area of pulmonary rehabilitation for cystic fibrosis in the form of questions and answers regarding interventions, indications, benefits and risks of pulmonary rehabilitation. Pulmonary rehabilitation includes airway clearance techniques, exercise training, education and behaviour change and can improve patients' exercise capacity, muscle strength, quality of life and nutritional status. Airway clearance techniques have beneficial effects for clearing mucous. Over the past years, evidence for the beneficial effects of exercise training on exercise capacity and overall lung health is growing. In cystic fibrosis, multiple factors result in reduced exercise capacity. All modalities of pulmonary rehabilitation should be offered to patients with cystic fibrosis, as the benefits in most cases outweigh the risks, though the optimal regimens need to be yet defined.
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Affiliation(s)
- Evgenia I Kalamara
- Respiratory Failure Unit, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece.
| | | | - Georgia Pitsiou
- Respiratory Failure Unit, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki; Medical School, Aristotle University of Thessaloniki, Greece.
| | - Guergana Petrova
- Medical University of Sofia; Pediatric Clinic, University Hospital Alexandrovska, Sofia, Bulgaria.
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Abstract
Cystic fibrosis (CF) is one of the most commonly diagnosed genetic disorders. Clinical characteristics include progressive obstructive lung disease, sinusitis, exocrine pancreatic insufficiency leading to malabsorption and malnutrition, liver and pancreatic dysfunction, and male infertility. Although CF is a life-shortening disease, survival has continued to improve to a median age of 46.2 years due to earlier diagnosis through routine newborn screening, promulgation of evidence-based guidelines to optimize nutritional and pulmonary health, and the development of CF-specific interdisciplinary care centers. Future improvements in health and quality of life for individuals with CF are likely with the recent development of mutation-specific modulator therapies. In this review, we will cover the current understanding of the disease manifestations, diagnosis, and management as well as common complications seen in individuals with CF.
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Affiliation(s)
- Kimberly M. Dickinson
- Johns Hopkins University, School of Medicine, Eudowood Division of Pediatric Respiratory Sciences, Baltimore, MD
| | - Joseph M. Collaco
- Johns Hopkins University, School of Medicine, Eudowood Division of Pediatric Respiratory Sciences, Baltimore, MD
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Unilateral temporary diaphragmatic paralysis secondary to bronchial artery embolization in a girl with cystic fibrosis and massive hemoptysis: a case report. BMC Pulm Med 2020; 20:38. [PMID: 32046694 PMCID: PMC7014762 DOI: 10.1186/s12890-020-1076-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Massive hemoptysis is a serious complication in Cystic Fibrosis (CF), occurring commonly in older patients. Bronchial artery embolization (BAE) can be performed to stop the bleeding. BAE is generally safe and effective, but can sometimes lead to serious complications. We report the first case of temporary unilateral diaphragmatic paralysis associated to lung consolidation following BAE in a pediatric CF female patient. This complication worsened the lung function of the patient who underwent lung transplantation after 9 months. Case presentation A 14 years old female CF patient followed by the CF center of Florence presented low-grade fever, cough increase and recurrent episodes of major hemorrhages such as to carry out a BAE. Within 24 h the patient started to complain of severe thoracic pain in the right hemithorax, increased dyspnea and fever. A computed tomographic angiography and a dynamic fluoroscopic evaluation revealed the right diaphragmatic paralysis, not present before the procedure. After 4 days the clinical condition and radiological imaging had improved with restored mobility of the right hemidiaphragm. Nine months later, she required mechanical ventilation, and subsequently the initiation of extracorporeal membrane oxygenation (ECMO) for a pulmonary exacerbation with septic shock. Lung transplantation in ECMO was performed with success. Conclusion Clinicians should be aware of the possibility of phrenic nerve injury with BAE in pediatric CF patients.
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Abstract
Antimicrobial therapies against cystic fibrosis (CF) lung infections are largely aimed at the traditional, well-studied CF pathogens such as Pseudomonas aeruginosa and Burkholderia cepacia complex, despite the fact that the CF lung harbors a complex and dynamic polymicrobial community. A clinical focus on the dominant pathogens ignores potentially important community-level interactions in disease pathology, perhaps explaining why these treatments are often less effective than predicted based on in vitro testing. Antimicrobial therapies against cystic fibrosis (CF) lung infections are largely aimed at the traditional, well-studied CF pathogens such as Pseudomonas aeruginosa and Burkholderia cepacia complex, despite the fact that the CF lung harbors a complex and dynamic polymicrobial community. A clinical focus on the dominant pathogens ignores potentially important community-level interactions in disease pathology, perhaps explaining why these treatments are often less effective than predicted based on in vitro testing. A better understanding of the ecological dynamics of this ecosystem may enable clinicians to harness these interactions and thereby improve treatment outcomes. Like all ecosystems, the CF lung microbial community develops through a series of stages, each of which may present with distinct microbial communities that generate unique host-microbe and microbe-microbe interactions, metabolic profiles, and clinical phenotypes. While insightful models have been developed to explain some of these stages and interactions, there is no unifying model to describe how these infections develop and persist. Here, we review current perspectives on the ecology of the CF airway and present the CF Ecological Succession (CFES) model that aims to capture the spatial and temporal complexity of CF lung infection, address current challenges in disease management, and inform the development of ecologically driven therapeutic strategies.
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Avdimiretz N, Glicksman A, Dell S, John P, Moraes TJ. Rare broncho-pulmonary arterial fistula in a healthy 9-year-old girl. BMJ Case Rep 2020; 13:e234865. [PMID: 33004353 PMCID: PMC7534672 DOI: 10.1136/bcr-2020-234865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 01/16/2023] Open
Abstract
A 9-year-old previously well girl presented with multiple episodes of large volume haemoptysis and right sided consolidation. She continued to have haemoptysis despite intravenous antibiotics. CT chest suggested a right mainstem endobronchial lesion; this was not seen on bronchoscopy where an extensive blood clot was removed. Distal flexible bronchoscopy could not identify the source of bleeding. CT angiogram revealed a broncho-pulmonary arterial fistula, a rare cause of haemoptysis in children. Endovascular embolisation resulted in short-term symptom resolution; however, haemoptysis recurred months later, leading to re-embolisation. This case highlights a stepwise approach to the workup of large volume haemoptysis.
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Affiliation(s)
- Nicholas Avdimiretz
- Pediatric Respirology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Amy Glicksman
- Pediatrics, Humber River Hospital, Toronto, Ontario, Canada
| | - Sharon Dell
- Pediatric Respirology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philip John
- Interventional Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Theo J Moraes
- Pediatric Respirology, Hospital for Sick Children, Toronto, Ontario, Canada
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Gavioli E, Aung CC. Haemoptysis management in cystic fibrosis: A case report and treatment pathway. J Clin Pharm Ther 2020; 45:845-847. [DOI: 10.1111/jcpt.13179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Gavioli
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences Brooklyn New York
- Mount Sinai Beth Israel New York New York
| | - Cho Cho Aung
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences Brooklyn New York
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Pavaut G, Kyheng M, Le Rouzic O, Perez T, Wallaert B, Prevotat A. Predictors of massive haemoptysis after a first episode of mild-to-moderate haemoptysis in patients with cystic fibrosis. ERJ Open Res 2020; 6:00382-2020. [PMID: 32963988 PMCID: PMC7487340 DOI: 10.1183/23120541.00382-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/19/2020] [Indexed: 11/21/2022] Open
Abstract
The main cause of death of cystic fibrosis (CF) patients is respiratory disease due to secondary infections, haemoptysis, pneumothorax, and respiratory failure [1]. In a study of 129 French CF patients who died between 2007 and 2010 without receiving lung transplantation, 8.5% of deaths were due to haemoptysis [2]. Factors associated with an increased risk of haemoptysis in CF patients include older age, advanced lung disease (forced expiratory volume in 1 s (FEV1) <70% predicted), airway colonisation by Pseudomonas aeruginosa [3], CF-related diabetes, portal hypertension, and liver cirrhosis [4]. To our knowledge, there have been no studies of the risk factors for the development of massive haemoptysis (MH) in CF patients who have previously experienced an episode of mild-to-moderate haemoptysis. Mild-to-moderate haemoptysis (m-mH) is common in patients with cystic fibrosis but the risk of subsequent massive haemoptysis (MH) is not known. Allergic bronchopulmonary aspergillosis and diabetes were significant predictors of MH subsequent to m-mH.https://bit.ly/30093Hw
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Montemayor K, Claudio AT, Carson S, Lechtzin N, Christianson MS, West NE. Unmasking catamenial hemoptysis in the era of CFTR modulator therapy. J Cyst Fibros 2020; 19:e25-e27. [PMID: 31987762 PMCID: PMC10657649 DOI: 10.1016/j.jcf.2020.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thoracic endometriosis syndrome (TES) is a rare condition that occurs in women when endometriosis implants into the thoracic cavity. Catamenial hemoptysis, the occurrence of hemoptysis with menstruation, is a recognized clinical manifestation of TES commonly treated with hormonal therapy. CASE SUMMARY We present the first documented case describing the recrudescence of catamenial hemoptysis in the setting of Lumacaftor/Ivacaftor administration in a 25-year-old woman with cystic fibrosis (CF). DISCUSSION We review the literature on TES, pharmacologic management, and reported cystic fibrosis transmembrane conductance regulator (CFTR) modulator drug interactions. We propose that our patient's recrudescence of catamenial hemoptysis was secondary to a drug-drug interaction between Lumacaftor/Ivacaftor and oral contraceptive therapy. CONCLUSION Our case suggests that women with CF who have catamenial hemoptysis and a genetic mutation approved for Tezacaftor/Ivacaftor or Elexacaftor/Tezacaftor/Ivacaftor can be managed effectively with either CFTR modulator and hormonal contraceptive therapy.
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Affiliation(s)
- Kristina Montemayor
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St 5th Floor, Baltimore, MD 21205, United States.
| | | | - Sara Carson
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St 5th Floor, Baltimore, MD 21205, United States
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St 5th Floor, Baltimore, MD 21205, United States
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States
| | - Natalie E West
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St 5th Floor, Baltimore, MD 21205, United States
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Olsen KM, Manouchehr-Pour S, Donnelly EF, Henry TS, Berry MF, Boiselle PM, Colletti PM, Harrison NE, Kuzniewski CT, Laroia AT, Maldonado F, Pinchot JW, Raptis CA, Shim K, Tong BC, Wu CC, Kanne JP. ACR Appropriateness Criteria® Hemoptysis. J Am Coll Radiol 2020; 17:S148-S159. [PMID: 32370959 DOI: 10.1016/j.jacr.2020.01.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Hemoptysis, the expectoration of blood, ranges in severity from nonmassive to massive. This publication reviews the literature on the imaging and treatment of hemoptysis. Based on the literature, the imaging recommendations for massive hemoptysis are both a chest radiograph and CT with contrast or CTA with contrast. Bronchial artery embolization is also recommended in the majority of cases. In nonmassive hemoptysis, both a chest radiograph and CT with contrast or CTA with contrast is recommended. Bronchial artery embolization is becoming more commonly utilized, typically in the setting of failed medical therapy. Recurrent hemoptysis, defined as hemoptysis that recurs following initially successful cessation of hemoptysis, is best reassessed with a chest radiograph and either CT with contrast or CTA with contrast. Bronchial artery embolization is increasingly becoming the treatment of choice in recurrent hemoptysis, with the exception of infectious causes such as in cystic fibrosis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Phillip M Boiselle
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Nicholas E Harrison
- Beaumont Health System, Royal Oak, Michigan; American College of Emergency Physicians
| | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | | | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Martin R, Arden M, Porritt J, Wildman M, Naughton F. Investigating the Temporal Relationships between Symptoms and Nebuliser Adherence in People with Cystic Fibrosis: A Series of N-of-1 Observations. Healthcare (Basel) 2020; 8:healthcare8010022. [PMID: 31972991 PMCID: PMC7151352 DOI: 10.3390/healthcare8010022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022] Open
Abstract
Treatment adherence in adults with cystic fibrosis (CF) is poor. One of the reasons identified for lack of adherence to nebulised treatments is that patients may not experience any immediate relief in their symptoms or notice changes as a result of taking their treatment, thus many report that they do not perceive there to be consequences of non adherence. The aim of the study was to investigate the temporal relationships between symptoms and adherence to nebulised treatments in adults with CF using an N-of-1 observational design. Six participants were recruited for a six-week period during which time they completed a daily online respiratory symptom questionnaire. Adherence to treatment was measured throughout the duration of the study using an eTrack® nebuliser that logged date and time of treatments taken. Data generated from each participant was analysed separately. There were significant relationships between pain and adherence for three participants, tiredness and adherence for one participant and cough and adherence for one participant. For all of these findings, the symptom and adherence were experienced on the same day. Extending the monitoring period beyond six weeks may provide increased insight into the complex relationship between symptoms and adherence in CF.
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Affiliation(s)
- Rosie Martin
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
- Correspondence:
| | - Madelynne Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | - Jenny Porritt
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield S10 2BQ, UK; (M.A.); (J.P.)
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
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Advanced Stage Lung Disease. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Romàn CM, Loughlin HC, Aliaj E, Fay RJ, Tran QT, Borowitz D. Hemoptysis from the perspective of people with cystic fibrosis. CLINICAL RESPIRATORY JOURNAL 2020; 14:299-303. [PMID: 31821725 PMCID: PMC7064971 DOI: 10.1111/crj.13132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/04/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
Introduction People with cystic fibrosis (CF) are living longer, thus complications associated with age, such as hemoptysis, are increasing. The Institute of Medicine has emphasized the importance of patient‐centeredness. Although guidelines about hemoptysis in people with CF are available, these focus on management of the complication and not the patient perspective. Objective We sought to understand hemoptysis from the point of view of those who have experienced it. Methods We fielded an 11‐question survey to adults with CF and asked those who had hemoptysis to respond. Four questions had open‐ended options: (1) the person’s first experience with hemoptysis, (2) how that experience affected the way they approach their CF, (3) how they deal with hemoptysis when it occurs outside the home and (4) a free text box for general comments. Results Thirty‐one of 132 adults with CF who were sent a survey completed it (23% response rate); 63% F), indicated that they had experienced hemoptysis and described their triggers. In response to open questioning, 77% of respondents found their first experience with hemoptysis to be ‘scary,’ ‘frightening,’ ‘worrying’ or ‘jarring.’ Half of respondents reported quality of life being negatively affected by worsening stress or anxiety, fear of bleeding in public or other life impacts. Conclusions Focusing on how to cope with future episodes of hemoptysis and the associated anxiety can be helpful to patients. Proactive communication and sensitivity to patient experience may deepen physician‐patient rapport, increase self‐efficacy to cope with future episodes and lead to more comprehensive care of hemoptysis.
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Affiliation(s)
| | | | - Enid Aliaj
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | | | | | - Drucy Borowitz
- Cystic Fibrosis Foundation, Bethesda, Maryland.,State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
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Schmid-Mohler G, Yorke J, Spirig R, Benden C, Caress AL. Adult patients' experiences of symptom management during pulmonary exacerbations in cystic fibrosis: A thematic synthesis of qualitative research. Chronic Illn 2019; 15:245-263. [PMID: 29742923 DOI: 10.1177/1742395318772647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective The aim of this review was to describe how patients experience an exacerbation of cystic fibrosis in terms of symptom management. Methods A systematic literature search was performed in MEDLINE, CINAHL, EMBASE, PSYCINFO and ASSIA. Studies were included that contained any direct quotes or summaries of quotes from patients with cystic fibrosis aged 16 or older and were related to symptom experience and management during an exacerbation. Framework analysis, guided by Symptom Management Theory, was used to present the findings. Results The review included 18 qualitative studies. In addition to physiological symptoms, patients highlighted the significant role of psychological symptoms. Delayed help-seeking was a common first response. Participants choose their self-management strategies taking both physiological and psychological symptoms into account. Maintaining normality was an important short-term outcome for patients, leading to conflict with health professionals. Patients’ symptom management during exacerbation was greatly influenced by the structure of cystic fibrosis care. Discussion Our findings provide an initial understanding of factors influencing patient self-management during an exacerbation. The transferal of these findings into clinical practice will provide a basis for shared goal setting and intervention planning. In addition, our findings have implications for future development of patient-reported outcome measures and intervention research.
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Affiliation(s)
| | - Janelle Yorke
- 2 Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - Rebecca Spirig
- 3 Directorate of Nursing and Allied Health Professionals, University Hospital Zurich, Zurich, Switzerland
| | - Christian Benden
- 4 Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Ann-Louise Caress
- 2 Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
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Zemanick E, Burgel PR, Taccetti G, Holmes A, Ratjen F, Byrnes CA, Waters VJ, Bell SC, VanDevanter DR, Stuart Elborn J, Flume PA. Antimicrobial resistance in cystic fibrosis: A Delphi approach to defining best practices. J Cyst Fibros 2019; 19:370-375. [PMID: 31680041 DOI: 10.1016/j.jcf.2019.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/10/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Antimicrobial susceptibility testing (AST) is a cornerstone of infection management in cystic fibrosis. However, there is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment. It has been suggested there is a need for careful consideration of current AST use by the CF community. METHODS We engaged a group of experts consisting of pulmonary (adult and pediatric) and infectious disease clinicians, microbiologists, and pharmacists representing a broad international experience. We conducted an iterative systematic survey (Delphi) to determine and quantify consensus regarding key questions facing CF clinicians in the use of respiratory culture results including what tests to order, when to obtain them, and how to act upon the results of the testing. RESULTS Consensus was reached for many questions but there was not universal agreement to the questions that were addressed. There were some differences with respect to cultures obtained for surveillance compared to when there is clinical worsening. Areas of general consensus include when and how respiratory cultures should be performed, what information should be reported, and when AST should be performed. A key finding is that clinical response to treatment is used to guide treatment decisions rather than AST results. CONCLUSIONS Recommendations are presented regarding questions related to microbiology testing for patients with CF. We have also offered recommendations for priority research questions.
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Affiliation(s)
- Edith Zemanick
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.
| | - Pierre-Régis Burgel
- Division of Respiratory Medicine and Adult Cystic Fibrosis Center, Assistance Publique Hôpitaux de Paris and University Paris Descartes, Paris, France; ERN-Lung cystic fibrosis network.
| | - Giovanni Taccetti
- Cystic Fibrosis Center, Department of Pediatrics, University of Florence, Italy.
| | - Alison Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London. United Kingdom.
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, Translational Medicine,Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland & Respiratory Department, Starship Children's Health, Auckland, New Zealand
| | - Valerie J Waters
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
| | - Scott C Bell
- Department of Thoracic Medicine, The Prince Charles Hospital and QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
| | - J Stuart Elborn
- Imperial College and Royal Brompton Hospital, London and Queen's University Belfast, United Kingdom.
| | - Patrick A Flume
- Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
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