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Observational Study
. 2013 Oct;163(4):1152-7.e2.
doi: 10.1016/j.jpeds.2013.05.013. Epub 2013 Jun 27.

Probability of treatment following acute decline in lung function in children with cystic fibrosis is related to baseline pulmonary function

Wayne J Morgan  1 , Jeffrey S Wagener, Ashley Yegin, David J Pasta, Stefanie J Millar, Michael W Konstan; Scientific Advisory Group, investigators; coordinators of the Epidemiologic Study of Cystic Fibrosis
Collaborators, Affiliations
Observational Study

Probability of treatment following acute decline in lung function in children with cystic fibrosis is related to baseline pulmonary function

Wayne J Morgan et al. J Pediatr. 2013 Oct.

Abstract

Objective: To determine whether the association between high forced expiratory volume in 1 second (FEV1) and increased rate of decline in FEV1 in children with cystic fibrosis could be due to less frequent intervention after acute declines (sudden decline events) in FEV1.

Study design: Patients with cystic fibrosis aged 6-17 years enrolled in the Epidemiologic Study of Cystic Fibrosis were assessed for a sudden decline event, defined as a 10% relative decline in FEV1% predicted from an average of 3 consecutive stable baseline spirometries. The likelihood of therapeutic intervention within 14 days before and 56 days after this event was then related to their baseline FEV1% predicted age-specific decile using a logistic regression adjusting for age group (6-12 years, 13-17 years) and presence of Pseudomonas aeruginosa on respiratory culture.

Results: A total of 10 888 patients had at least 1 sudden decline event in FEV1. Patients in the highest FEV1 decile were significantly less likely than those in the lowest decile to receive intravenous antibiotics (OR, 0.14; 95% CI, 0.11-0.18; P < .001) or be hospitalized (OR, 0.18; 95% CI, 0.14-0.23; P < .001) following decline.

Conclusions: Children and adolescents with high baseline lung function are less likely to receive a therapeutic intervention following an acute decline in FEV1, which may explain their greater rate of FEV1 decline.

Keywords: CF; Cystic fibrosis; ESCF; Epidemiologic Study of Cystic Fibrosis; FEV(1); Forced expiratory volume in 1 second; IV; Intravenous.

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Figures

Figure 1
Figure 1
Analytical schema showing the baseline FEV1 averaged from three values obtained at a time of clinical stability (open circles) followed by a decline in FEV1 below the threshold of a 10% relative decline (filled square). Therapeutic interventions included new antibiotic therapy (evaluated from 14 days before until 56 days following the decline) and hospitalization (evaluated only for 56 days following the decline).
Figure 2
Figure 2
Therapeutic intervention by baseline lung function decile by age group. P <.001 for linear trend by severity deciles for both age groups and for both intravenous antibiotic therapy (A) and hospitalization (B).
Figure 3
Figure 3
Frequency distribution of new antibiotic interventions (evaluated from 14 days before until 56 days following the decline) and hospitalizations (evaluated only for 56 days following the decline), by baseline lung function decile by age group.
See this image and copyright information in PMC

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