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. 2012 Sep;11(5):405-11.
doi: 10.1016/j.jcf.2012.03.009. Epub 2012 May 5.

Risk factors for rate of decline in FEV1 in adults with cystic fibrosis

Michael W Konstan  1 , Jeffrey S Wagener, Donald R Vandevanter, David J Pasta, Ashley Yegin, Lawrence Rasouliyan, Wayne J Morgan
Affiliations

Risk factors for rate of decline in FEV1 in adults with cystic fibrosis

Michael W Konstan et al. J Cyst Fibros. 2012 Sep.

Abstract

Background: Previously we assessed risk factors for FEV(1) decline in children and adolescents using the Epidemiologic Study of Cystic Fibrosis (J Pediatr 2007;151:134-139); the current study assessed risk factors in adults.

Methods: Risk factors for FEV(1) decline over 3-5.5 years for ages 18-24 and ≥25 years were assessed using mixed-model regression.

Results: Mean rates of FEV(1) decline (% predicted/year) were -1.92 for ages 18-24y (n=2793) and -1.45 for ages ≥25y (n=1368). For the 18-24y group, B. cepacia, pancreatic enzyme use, multidrug-resistant P. aeruginosa, cough, mucoid P. aeruginosa, and female sex predicted greater decline; low baseline FEV(1) and sinusitis predicted less decline. For the ≥25y group, only pancreatic enzyme use predicted greater decline; low baseline FEV(1) and sinusitis predicted less decline.

Conclusions: Risk factors for FEV(1) decline in adults <25 years are similar to those previously identified in children and adolescents; older adults had few statistically significant risk factors.

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Figures

Figure 1
Figure 1. Schematic of study design
Figure 2
Figure 2. Patient disposition
Figure 3
Figure 3. Estimated decline in FEV1% predicted by age group
Vectors representing the observed average changes in FEV1 % predicted over the study period for the two adult age groups in this study are plotted together with 3 vectors previously published for younger patients with CF. For each age group, the line segment is positioned to begin at the mean age at study baseline and extends to cover the central 90% of follow-up (approximately 5 years). For example, the line for the age ≥25y group is centered at about age 35 and extends about 5 years, but represents the average decline over a 5-year period across all ages 25 and older.
Figure 4
Figure 4. Results of multivariable models of FEV1 percent predicted by age group
Risk factors remaining in the final multivariable regression (Table 2) are shown in the left column. For a patient in either the 18-24y group (left) or ≥25y group (right), an estimate of the rate of annual decline in FEV1 percent predicted is obtained by summing parameter estimates (labeled “Est.”) associated with each variable state for the patient. The graphical display shows the reference line (mean rate of decline for each age group), the estimated effect of each variable, and the associated 95% confidence interval.
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References

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