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Ahmed MI, Dayman N, Blyth N, Madge J, Gaillard E. Impact of CFTR modulators on exercise capacity in adolescents with cystic fibrosis. ERJ Open Res 2024; 10:00687-2023. [PMID: 38375430 PMCID: PMC10875456 DOI: 10.1183/23120541.00687-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Exercise capacity is an independent predictor of clinical worsening in cystic fibrosis (CF). There is limited evidence of the impact of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on exercise capacity in children with CF. The aim of the present study was to assess the impact of CFTR modulators on exercise capacity in a cohort of adolescents with CF. METHODS A prospective single-centre cohort study was carried out. Cardiopulmonary exercise testing (CPET) was performed at baseline, prior to starting Symkevi or Kaftrio and between 4 and 8 months after starting treatment. RESULTS 19 adolescents with CF had CPET performed prior to and after CFTR modulator treatment, between December 2019 and March 2022. Breathing reserve improved in the whole cohort, with greater improvement in the modulator-naïve patients after starting treatment with Kaftrio. There was no improvement in peak oxygen uptake and anaerobic threshold after 4 to 8 months of treatment with CFTR modulators. CONCLUSION Exercise testing with CPET can be used as an additional tool to monitor response to CFTR modulators. Breathing reserve on CPET may provide a surrogate marker to monitor the improvement in CF lung disease with CFTR modulator treatment.
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Affiliation(s)
- Molla Imaduddin Ahmed
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory sciences, University of Leicester, Leicester, UK
| | - Naomi Dayman
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory sciences, University of Leicester, Leicester, UK
| | - Natalie Blyth
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joe Madge
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Erol Gaillard
- Department of Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory sciences, University of Leicester, Leicester, UK
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2
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Fouzas S, Kogias C, Gioulvanidou M, Bertzouanis A, Chrysochoou EA, Anthracopoulos MΒ, Tsanakas J, Hatziagorou E. Low-frequency oscillometry indices to assess ventilation inhomogeneity in CF patients. Pediatr Pulmonol 2023; 58:3147-3155. [PMID: 37555768 DOI: 10.1002/ppul.26635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The utility of the forced oscillations technique (FOT) in cystic fibrosis (CF) remains uncertain. The aim of this study was to explore the ability of lower-frequency FOT indices, alone and after adjustment for the lung volume, to assess the extent of ventilation inhomogeneity in CF patients with varying disease severity. METHODS Forty-five children, adolescents, and adults with CF (age 6.9-27 years) underwent spirometry, FOT, and nitrogen multiple-breath washout (N2-MBW) measurements. The respiratory resistance and reactance at 5 Hz (Rrs5 and Xrs5, respectively) were recorded, and a novel FOT index, the specific respiratory conductance (sGrs), was computed as the reciprocal of Rrs5 divided by the functional residual capacity. RESULTS The sGrs correlated well with the lung clearance index (LCI) (Spearman's r: -.797), whereas the correlation of Rrs5 and Xrs5 with the LCI, albeit significant, was weaker (r: .643 and -.631, respectively). The sGrs emerged as the most robust predictor of LCI regardless of the severity of lung disease, as reflected by patients' age and lung function measurements. Most importantly, the relationship between sGrs and LCI remained unaffected by lung hyperinflation, as opposed to that of the LCI with the spirometric and standard FOT indices. CONCLUSIONS In CF patients, the FOT indices at 5 Hz and the novel, volume-adjusted parameter sGrs, reflect the extent of lung involvement and the underlying ventilation inhomogeneity in a way comparable to N2-MBW. Future research should explore the role of lower-frequency FOT in assessing the severity and monitoring the progression of CF lung disease.
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Affiliation(s)
- Sotirios Fouzas
- Pediatric Respiratory Unit, Pediatric Department, University Hospital of Patras, Patras, Greece
| | - Christos Kogias
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Gioulvanidou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Bertzouanis
- Pediatric Respiratory Unit, Pediatric Department, University Hospital of Patras, Patras, Greece
| | - Elisavet-Anna Chrysochoou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - John Tsanakas
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elpis Hatziagorou
- Pediatric Respiratory and Cystic Fibrosis Unit, 3rd Paediatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tomlinson OW, Saynor ZL, Stevens D, Antoun J, Urquhart DS, Williams CA. Survey of exercise testing and training in cystic fibrosis clinics in the UK: a decade of progress. BMJ Open 2023; 13:e072461. [PMID: 37116999 PMCID: PMC10151857 DOI: 10.1136/bmjopen-2023-072461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES Regular exercise testing is recommended for people with cystic fibrosis (pwCF), as is the provision and regular review of exercise training programmes. A previous survey on exercise testing and training for pwCF in the UK was conducted over a decade ago. With the landscape of CF changing considerably during this time, this survey aimed to evaluate UK-based exercise testing and training practices for pwCF a decade on. DESIGN Cross-sectional, online survey. PARTICIPANTS A survey was distributed electronically to UK CF clinics and completed by the individual primarily responsible for exercise services. Descriptive statistics and qualitative analyses were undertaken. RESULTS In total, 31 CF centres participated, representing ~50% of UK specialist clinics. Of these, 94% reported using exercise testing, 48% of which primarily use cardiopulmonary exercise testing. Exercise testing mostly occurs at annual review (93%) and is most often conducted by physiotherapists (62%). A wide variation in protocols, exercise modalities, normative reference values and cut-offs for exercise-induced desaturation are currently used. All centres reportedly discuss exercise training with pwCF; 94% at every clinic appointment. However, only 52% of centres reportedly use exercise testing to inform individualised exercise training. Physiotherapists typically lead discussions around exercise training (74%). CONCLUSIONS These data demonstrate that the majority of respondent centres in the UK now offer some exercise testing and training advice for pwCF, representing a marked improvement over the past decade. However, continued efforts are now needed to standardise exercise practices, particularly regarding field testing practices and the translation of test results into personalised training programmes for pwCF.
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Affiliation(s)
- Owen William Tomlinson
- Children's Health and Exercise Research Centre, Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health & Exercise Science, Faculty of Science & Health, University of Portsmouth, Portsmouth, UK
| | - Daniel Stevens
- School of Health and Human Performance, Division of Kinesiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joe Antoun
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health & Exercise Science, Faculty of Science & Health, University of Portsmouth, Portsmouth, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Craig Anthony Williams
- Children's Health and Exercise Research Centre, Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
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4
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Stanford G, Daniels T, Brown C, Ferguson K, Prasad A, Agent P, Gates A, Morrison L. Role of the Physical Therapist in Cystic Fibrosis Care. Phys Ther 2022; 103:pzac136. [PMID: 36193006 PMCID: PMC9619615 DOI: 10.1093/ptj/pzac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022]
Abstract
In looking back on 2020 and 2021, this Perspective reflects on the monumental impacts of the rollout of cystic fibrosis (CF) transmembrane conductance regulator highly effective modulator therapies and the COVID-19 pandemic on the management of CF. Advancements in the clinical management of people with CF have been both enormous and rapid, and physical therapists specializing in the care of people with CF have been at the forefront of driving this evolution in care. This year sees the 30th anniversary of the UK Association of Chartered Physiotherapists in Cystic Fibrosis and, as is inevitable in reaching such milestones, thoughts have turned to origins, role, impacts, and the future. With the changing demographics of the population of people with CF after the introduction of highly effective modulator therapies, potentially with fewer secondary complications, the future role of the physical therapist who specializes in CF is in question. This Perspective reflects on and highlights the role of physical therapy within CF and provides insights into how physical therapists and respiratory therapists can evolve their roles to ensure relevance for the future.
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Affiliation(s)
- Gemma Stanford
- Royal Brompton and Harefield Hospitals, Guys and St. Thomas’ NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Tracey Daniels
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- York Hull Adult Cystic Fibrosis Centre, York Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - Catherine Brown
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- West Midlands Adult Cystic Fibrosis Centre, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Katie Ferguson
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Ammani Prasad
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Penny Agent
- Royal Brompton and Harefield Hospitals, Guys and St. Thomas’ NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alison Gates
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- Oxford Adult Cystic Fibrosis Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Lisa Morrison
- Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) c/o ACPCF Secretary, Infection, Immunity & Inflammation Dept, University College London Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- West of Scotland Adult Cystic Fibrosis Service, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
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Urquhart DS, Cunningham S, Taylor E, Vogiatzis I, Allen L, Lewis S, Neilson AR, Soilemezi D, Akooji N, Saynor ZL. Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial. NIHR OPEN RESEARCH 2022; 2:64. [PMID: 37881306 PMCID: PMC10593342 DOI: 10.3310/nihropenres.13347.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 10/27/2023]
Abstract
Background Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The 'ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis' trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability. Methods Multi-centre, two-arm, randomised (1:1 allocation using minimisation), pilot trial at two sites. Fifty pwCF (≥10 years, FEV 1 >40% predicted, stable on Elexacaftor/Tezacaftor/Ivacaftor (ETI)) will be randomised to an individually-customised ExACT programme (≥once daily aerobic exercise of ≥20-minutes duration at an intensity that elicits deep breathing, with huffs and coughs), or usual care. After baseline assessments, secondary outcomes will be assessed after 28-days, with additional home lung function and exacerbation questionnaires at 7, 14 and 21-days, physical activity and sleep monitoring throughout, and embedded qualitative and health-economic components. Feasibility measures include recruitment, retention, measurement completion, adverse events, interviews exploring the acceptability of trial procedures, and a trial satisfaction questionnaire. Discussion Co-designed with the UK CF community, the ExACT-CF pilot trial is the first multi-centre RCT to test the feasibility of recruiting pwCF stable on ETI into a trial investigating ExACT. This pilot trial will inform the feasibility, design, management, likely external validity for progression to a main phase randomised controlled trial. Registration Clinicaltrials.gov ( NCT05482048).
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Affiliation(s)
- Don S. Urquhart
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Steve Cunningham
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Emily Taylor
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | | | - Steff Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Dia Soilemezi
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Naseerah Akooji
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Zoe L. Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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6
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Britto CJ, Ratjen F, Clancy JP. Emerging Approaches to Monitor and Modify Care in the Era of Cystic Fibrosis Transmembrane Conductance Regulators. Clin Chest Med 2022; 43:631-646. [PMID: 36344071 DOI: 10.1016/j.ccm.2022.06.006] [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: 11/06/2022]
Abstract
As we characterize the clinical benefits of highly effective modulator therapy (HEMT) in the cystic fibrosis (CF) population, our paradigm for treating and monitoring disease continues to evolve. More sensitive approaches are necessary to detect early disease and clinical progression. This article reviews evolving strategies to assess disease control and progression in the HEMT era. This article also explores developments in pulmonary function monitoring, advanced respiratory imaging, tools for the collection of patient-reported outcomes, and their application to profile individual responses, guide therapeutic decisions, and improve the quality of life of people with CF.
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Affiliation(s)
- Clemente J Britto
- Yale Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine.
| | - Felix Ratjen
- Division of Respiratory Medicine, Translational Medicine, University of Toronto Hospital for Sick Children, 555 University Avenue, Toronto Ontario M5G 1X8, Canada
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7
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Gambazza S, Mariani A, Brivio A, Carta F, Blardone C, Lisiero S, Russo M, Colombo C. Time Free From Hospitalization in Children and Adolescents With Cystic Fibrosis: Findings From FEV 1, Lung Clearance Index and Peak Work Rate. Front Pediatr 2022; 10:926248. [PMID: 35813385 PMCID: PMC9257036 DOI: 10.3389/fped.2022.926248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An exercise test combined with a multiple breath washout nitrogen test (MBWN2) may offer a comprehensive clinical evaluation of cystic fibrosis (CF) disease in children with normal spirometry. The purpose of the present study is to explore whether information derived from spirometry, MBWN2, and exercise tests can help the CF multidisciplinary team to characterize time free from hospitalization due to pulmonary exacerbation (PE) in a cohort of pediatric patients with CF. METHODS This prospective observational study was carried out at the Lombardia Region Reference Center for Cystic Fibrosis in Milano, Italy. In 2015, we consecutively enrolled children and adolescents aged <18 years with spirometry, MBWN2, and Godfrey exercise test performed during an outpatient visit. RESULTS Over a median follow-up time of 2.2 years (interquartile range [IQR], 2.01; 3.18), 28 patients aged between 13.0 and 17.4 years were included. When lung functions were outside the normal range, 50% of patients were hospitalized 4 months after the outpatient visit, and their response to exercise was abnormal (100%). Half of the individuals with normal forced expiratory volume in the first second (FEV1) and abnormal lung clearance index (LCI) experienced the first hospital admission 9 months after the clinic visit, and 84.2% presented an abnormal response to exercise. Conversely, 15.8% had abnormal exercise responses when lung functions were considered normal, with half of the adolescents hospitalized at 11 months. CONCLUSION Maintaining ventilation homogeneity, along with a normal ability to sustain intense work, may have a positive impact on the burden of CF disease, here conceived as time free from hospitalization due to PE.
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Affiliation(s)
- Simone Gambazza
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Healthcare Professions Department, Milan, Italy
| | - Alessandra Mariani
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Healthcare Professions Department, Milan, Italy.,Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre of Milan, Milan, Italy
| | - Anna Brivio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Healthcare Professions Department, Milan, Italy.,Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre of Milan, Milan, Italy
| | - Federica Carta
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Healthcare Professions Department, Milan, Italy.,Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre of Milan, Milan, Italy
| | - Chiara Blardone
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Healthcare Professions Department, Milan, Italy.,Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre of Milan, Milan, Italy
| | - Saba Lisiero
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Healthcare Professions Department, Milan, Italy.,Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre of Milan, Milan, Italy
| | - Maria Russo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Cystic Fibrosis Centre of Milan, Milan, Italy
| | - Carla Colombo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Healthcare Professions Department, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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8
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Laveneziana P, Palange P. Ventilatory efficiency and its clinical and prognostic value in adults with cystic fibrosis. Eur Respir Rev 2021; 30:30/162/200395. [PMID: 34853094 DOI: 10.1183/16000617.0395-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/08/2021] [Indexed: 11/05/2022] Open
Abstract
Cystic fibrosis, due to the absence or abnormal function of the cystic fibrosis transmembrane conductance regulator, is the most common life-limiting autosomal recessive genetic disorder among the Caucasian population. The lungs are particularly affected due to thick and tenacious mucus causing parenchymal anomalies ranging from bronchiectasis, progressive airflow limitation, respiratory infections, lung destruction and ultimately respiratory failure. Despite the remarkable advances in treatment that have greatly improved survival, most patients experience progressive exercise curtailment, with the consequence that a growing number of patients with cystic fibrosis will be referred for exercise-based evaluations in the forthcoming years. Cardiopulmonary exercise testing, in particular, is a useful tool to assess the mechanisms of exercise intolerance in individual patients that may have treatment and prognostic implications. In this review, we will focus on ventilatory efficiency and its clinical and prognostic value in adults with cystic fibrosis.
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Affiliation(s)
- Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Paolo Palange
- Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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9
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Chin M, Aaron SD. Disconcerting and Counter-Intuitive Findings from a Trial of Exercise in Cystic Fibrosis- Can Exercise Make our Patients Worse? Am J Respir Crit Care Med 2021; 205:269-270. [PMID: 34856109 PMCID: PMC8887002 DOI: 10.1164/rccm.202110-2446ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Melanie Chin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;
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