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Pulmonary Exacerbations (pulmonary + exacerbation)
Kinds of Pulmonary Exacerbations Selected AbstractsPulmonary exacerbations in cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 5 2004Harvey R. Rabin MD Abstract The clinical characteristics most relevant to the decision to treat for a pulmonary exacerbation with antibiotics in cystic fibrosis patients were determined. Variables including age, increased cough frequency and sputum production, new crackles and wheezing, asthma, symptomatic sinusitis, hemoptysis, decreased lung function, weight loss, and new acquisition of Pseudomonas aeruginosa were collected in a large prospective multicenter database (Epidemiologic Study of Cystic Fibrosis). During a 12-month baseline period, data from 11,692 patients were compared with data collected during the subsequent 6-month study period. Because pulmonary function assessments were unavailable for patients <6 years of age, separate analyses were done for those <6 and ,6 years of age. The outcome of interest was any antibiotic treatment in the 6-month study period reported as indicated for an exacerbation. Characteristics with the most discriminatory power were determined using stepwise multiple logistic regression. For patients <6 years of age, the strongest independent associations with treatment for a pulmonary exacerbation were new crackles, increased cough frequency, decline in weight, and increased sputum production. For those patients ,6 years of age, the strongest independent associations were a relative decrease in percent predicted forced expired volume in 1 sec, increased cough frequency, new crackles, and hemoptysis. The presence of three or more of these key characteristics was strongly associated with the occurrence of a treated exacerbation. The reproducibility of the model over time was confirmed by application to a subsequent set of data. This model has potential for use as an outcome measure in clinical trials, and to assist in treatment decisions for individual patients. Pediatr Pulmonol. 2004; 37:400,406. © 2004 Wiely-Liss, Inc. [source] Using index of ventilation to assess response to treatment for acute pulmonary exacerbation in children with cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 8 2009FRACP, Paul D. Robinson MRCPCH Abstract Background The use of alternative more sensitive measures has become a focus of research in CF. The utility of indexes of ventilation, Lung Clearance Index (LCI) and peak aerobic capacity (peak VO2), were studied as assessment tools in gauging response to intravenous (IV) therapy in acute pulmonary exacerbation, in comparison to the more commonly used index of forced expiratory volume in 1,sec (FEV1). The utility of a previously published clinical score was further explored. Methods Patients aged 8,18 years admitted for IV antibiotic treatment of a pulmonary exacerbation were recruited. Spirometry, plethysmography, multiple breath nitrogen washout, exercise testing, and Cystic Fibrosis Clinical Score (CFCS) were performed on admission and prior to discharge. Results Twenty-eight patients were recruited, with a mean (range) age of 13.7 (8; 17) years, 16 female and 12 male. Mean (range) admission FEV1 was 61.4 (28; 92)% predicted, or z -score ,3.09 (,6.15; ,0.52), FVC 83.0 (38; 120)% predicted, or z -score ,1.71 (,5.66; ,1.17), and Shwachman,Kulczycki 68.9 (50; 90). FEV1 increased by 7.0% (P,<,0.01) from admission to discharge. Mean (range) admission LCI, 10.10 (6.87; 14.83), decreased by 3.8% (P,=,0.03). Mean (range) admission peak VO2 (ml/kg/min), 31.2 (23.4; 45.4), increased on discharge by 6.6% (P,<,0.01). Proposed clinical thresholds, based on the available variability data, highlighted the heterogeneity of response in lung function tests. Mean (range) admission CFCS, 26.5 (19; 39), decreased to 19.9 (13; 31) on discharge, a 25.2% improvement (P,<,0.01). CFCS demonstrated improvement in 27 of 28 patients. Changes in peak VO2 (r,=,,0.50, P,=,0.02) and LCI (r,=,0.48, P,=,0.01) correlated with CFCS change. Conclusions In children with mild-to-moderate CF, whilst statistically significant improvement in both LCI and peak VO2 were seen, heterogeneity of response was evident. The most consistent improvement was seen in CFCS. Correlation of LCI and peak VO2 with change in clinical score (CFCS) was seen. The full clinical significance of these changes in LCI and peak VO2 needs to be evaluated further with additional variability data. The CFCS may be useful in the assessment of response to treatment in CF but requires formal validation. Pediatr Pulmonol. 2009; 44:733,742. © 2009 Wiley-Liss, Inc. [source] Reproducibility of spirometry during cystic fibrosis pulmonary exacerbations,,PEDIATRIC PULMONOLOGY, Issue 11 2008Don B. Sanders MD Abstract Objectives: To compare the within day variation of spirometry between hospital admission, discharge, and outpatient follow up among children with cystic fibrosis (CF) hospitalized for a pulmonary exacerbation. Hypothesis: Within day variation of spirometry will be greater at hospital admission than at hospital discharge or outpatient follow up. Methods: We performed a retrospective review of spirometry data for all patients with CF ,6 years old admitted to our pediatric CF center for a pulmonary exacerbation in 2004 or 2005. For patients who had previously performed spirometry successfully, measurements were used from one admission only during 2004,2005 if the spirometry occurred within 3 days of hospital admission, 3 days of discharge, or at a follow up clinic visit when well. We compared the within day coefficients of variation (CV) for FVC, FEV1, and FEF25,75 between time points using the Wilcoxon signed rank-test. We also determined the change in spirometry that is likely to be beyond measurement variability during inpatient treatment of a pulmonary exacerbation. Results: Spirometry data were available from 40 subjects at admission and follow up and 35 at hospital discharge. There was no significant difference in CV at admission, discharge, and follow up for FVC, FEV1, or FEF25,75. The mean (SD) CV was 3.1% (2.7) for FVC, 3.2% (2.1) for FEV1, and 9.7% (7.0) for FEF25,75 at admission, 2.8% (2.2) for FVC, 3.1% (2.1) for FEV1, and 8.1% (6.7) for FEF25,75 at discharge, and 2.7% (1.7) for FVC, 2.8% (2.0) for FEV1, and 8.4% (7.8) for FEF25,75 at follow up. These are similar to previous reports of outpatients with CF. The improvement in spirometry that exceeded measurement variability for our cohort was 80 ml for FVC, 70 ml for FEV1, and 220 ml/sec for FEF25,75. Conclusions: The presence of an acute pulmonary exacerbation in children and adolescents with CF does not substantially contribute to the within day variation in spirometry. Within day variation of spirometry for children with CF during pulmonary exacerbations is similar to previously reported values from clinically stable CF patients. Pediatr. Pulmonol. 2008; 43:1142,1146. © 2008 Wiley-Liss, Inc. [source] Pulmonary exacerbations in cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 5 2004Harvey R. Rabin MD Abstract The clinical characteristics most relevant to the decision to treat for a pulmonary exacerbation with antibiotics in cystic fibrosis patients were determined. Variables including age, increased cough frequency and sputum production, new crackles and wheezing, asthma, symptomatic sinusitis, hemoptysis, decreased lung function, weight loss, and new acquisition of Pseudomonas aeruginosa were collected in a large prospective multicenter database (Epidemiologic Study of Cystic Fibrosis). During a 12-month baseline period, data from 11,692 patients were compared with data collected during the subsequent 6-month study period. Because pulmonary function assessments were unavailable for patients <6 years of age, separate analyses were done for those <6 and ,6 years of age. The outcome of interest was any antibiotic treatment in the 6-month study period reported as indicated for an exacerbation. Characteristics with the most discriminatory power were determined using stepwise multiple logistic regression. For patients <6 years of age, the strongest independent associations with treatment for a pulmonary exacerbation were new crackles, increased cough frequency, decline in weight, and increased sputum production. For those patients ,6 years of age, the strongest independent associations were a relative decrease in percent predicted forced expired volume in 1 sec, increased cough frequency, new crackles, and hemoptysis. The presence of three or more of these key characteristics was strongly associated with the occurrence of a treated exacerbation. The reproducibility of the model over time was confirmed by application to a subsequent set of data. This model has potential for use as an outcome measure in clinical trials, and to assist in treatment decisions for individual patients. Pediatr Pulmonol. 2004; 37:400,406. © 2004 Wiely-Liss, Inc. [source] One-year glargine treatment can improve the course of lung disease in children and adolescents with cystic fibrosis and early glucose derangementsPEDIATRIC DIABETES, Issue 3 2009Enza Mozzillo Background:, Diabetes increases morbidity and mortality in cystic fibrosis (CF) patients, but several studies indicate that also prediabetic status may have a potential impact on both nutrition and lung function. Objective:, To evaluate the effect of glargine on the clinical course in CF patients with early glucose derangements. Methods:, CF population was screened for glucose tolerance. CF patients with age >10 yr were screened with fasting hyperglycemia (FH). CF patients with age >10 yr without FH and those with age <10 yr with occasional FH were evaluated for glucose abnormalities on the basis of oral glucose tolerance test and/or continuous glucose monitoring system. All CF patients with glucose derangements were enrolled in an open clinical trial with glargine. Body mass index (BMI) z-score, forced expiratory volume in the first second (FEV1), number of acute pulmonary exacerbations and hemoglobin A1c, were as outcome measures at baseline and after 1 yr of treatment. Results:, After 12 months of therapy, BMI z-score improved only in patients with baseline BMI z-score less than ,1 (p = 0.017). An 8.8% increase in FEV1 (p = 0.01) and 42% decrease in the number of pulmonary exacerbations (p = 0.003) were found in the whole group compared with previous 12 months of therapy. Conclusion:, Glargine could represent an innovative strategy to prevent lung disease progression in CF patients with early glucose derangements. Larger controlled trials are needed to better clarify the effects of insulin on clinical status in CF patients with early glucose derangements. [source] Probiotic supplementation affects pulmonary exacerbations in patients with cystic fibrosis: A pilot studyPEDIATRIC PULMONOLOGY, Issue 6 2010Batia Weiss MD Abstract Objective Probiotics reduce intestinal inflammation in, and Lactobacillus GG (LGG) reduces pulmonary exacerbation rate cystic fibrosis (CF) patients. We intended to determine the effect of a mixed probiotic preparation on pulmonary exacerbations and inflammatory characteristics of the sputum in CF patients. Study Design A prospective pilot study of 10 CF patients with mild,moderate lung disease and Pseudomonas aeruginosa colonization, treated with probiotics for 6 months. Pulmonary function tests (PFT's), sputum cultures with semi-quantitative bacterial analysis, and sputum neutrophil count and interleukin-8 (IL-8) levels were compared to pre-treatment and post-treatment values. The rate of pulmonary exacerbations was compared to 2 years prior to the study. Results The exacerbation rate was significantly reduced in comparison to the previous 2 years and to 6 months post-treatment (P,=,0.002). PFT's have not changed at the end of treatment and during 6 months post-treatment. No change in sputum bacteria, neutrophil count, and IL-8 levels was observed. Conclusion Probiotics reduce pulmonary exacerbations rate in patients with CF. Probiotics may have a preventive potential for pulmonary deterioration in CF patients. Pediatr Pulmonol. 2010; 45:536,540. © 2010 Wiley-Liss, Inc. [source] Reproducibility of spirometry during cystic fibrosis pulmonary exacerbations,,PEDIATRIC PULMONOLOGY, Issue 11 2008Don B. Sanders MD Abstract Objectives: To compare the within day variation of spirometry between hospital admission, discharge, and outpatient follow up among children with cystic fibrosis (CF) hospitalized for a pulmonary exacerbation. Hypothesis: Within day variation of spirometry will be greater at hospital admission than at hospital discharge or outpatient follow up. Methods: We performed a retrospective review of spirometry data for all patients with CF ,6 years old admitted to our pediatric CF center for a pulmonary exacerbation in 2004 or 2005. For patients who had previously performed spirometry successfully, measurements were used from one admission only during 2004,2005 if the spirometry occurred within 3 days of hospital admission, 3 days of discharge, or at a follow up clinic visit when well. We compared the within day coefficients of variation (CV) for FVC, FEV1, and FEF25,75 between time points using the Wilcoxon signed rank-test. We also determined the change in spirometry that is likely to be beyond measurement variability during inpatient treatment of a pulmonary exacerbation. Results: Spirometry data were available from 40 subjects at admission and follow up and 35 at hospital discharge. There was no significant difference in CV at admission, discharge, and follow up for FVC, FEV1, or FEF25,75. The mean (SD) CV was 3.1% (2.7) for FVC, 3.2% (2.1) for FEV1, and 9.7% (7.0) for FEF25,75 at admission, 2.8% (2.2) for FVC, 3.1% (2.1) for FEV1, and 8.1% (6.7) for FEF25,75 at discharge, and 2.7% (1.7) for FVC, 2.8% (2.0) for FEV1, and 8.4% (7.8) for FEF25,75 at follow up. These are similar to previous reports of outpatients with CF. The improvement in spirometry that exceeded measurement variability for our cohort was 80 ml for FVC, 70 ml for FEV1, and 220 ml/sec for FEF25,75. Conclusions: The presence of an acute pulmonary exacerbation in children and adolescents with CF does not substantially contribute to the within day variation in spirometry. Within day variation of spirometry for children with CF during pulmonary exacerbations is similar to previously reported values from clinically stable CF patients. Pediatr. Pulmonol. 2008; 43:1142,1146. © 2008 Wiley-Liss, Inc. [source] Novel approach to the eradication of Pseudomonas aeruginosa in an infant with CF after outpatient treatment failure,PEDIATRIC PULMONOLOGY, Issue 5 2008Don Hayes Jr. MD Abstract Intravenous continuous infusion of betalactam (CIBL) antibiotic and high dose extended interval (HDEI) aminoglycoside therapy theoretically maximize bacterial killing in treatment of Pseudomonas aeruginosa (PsA) in pulmonary exacerbations of cystic fibrosis (CF). We present the case of a 3-month-old female infant with CF who failed outpatient eradication of PsA with subsequent eradication using intravenous CIBL antibiotic and HDEI aminoglycoside therapy. This antibiotic combination should be considered in order to optimize pharmacodynamics for PsA eradication in CF patients before development of chronic colonization. Pediatr Pulmonol. 2008; 43:511,513. © 2008 Wiley-Liss, Inc. [source] Human metapneumovirus and respiratory syncytial virus infections in older children with cystic fibrosisPEDIATRIC PULMONOLOGY, Issue 1 2007Daniel F. Garcia MD Abstract Background: Human metapneumovirus (hMPV) has been isolated from children with acute respiratory infection worldwide. Its epidemiology remains to be defined in children with cystic fibrosis (CF). We describe the epidemiology and clinical impact of hMPV in CF children and compared it to respiratory syncytial virus (RSV). Methods: CF children ages 7,18 years were studied prospectively during the 1998,1999 RSV season. Nasopharyngeal specimens were collected during acute respiratory illnesses and tested for respiratory viruses. Blood specimens were drawn early, mid, and end of the RSV season, and tested for serological evidence of hMPV and RSV infections. Rates of lower respiratory tract illnesses (LRTI) and hospitalizations for pulmonary exacerbations were compared during the time intervals they developed serological evidence of infection to their non-infection intervals. Results: Six of 44 CF children had a virus positive respiratory illness in 56 LTRI events and 18 hospitalizations. Serological evidence of hMPV and RSV infections occurred in 16 and 20 CF children, respectively; 8 had infections with both viruses. A greater proportion of CF children had ,1 LRTI during their infection intervals compared to their non-infection intervals (13/25 vs. 5/25; P,=,0.03). A trend for higher rates of LRTI was observed in the infection intervals compared to non-infection intervals (9.5,±,11.0 vs. 4.2,±,9.9 per 1,000 child-days; P,=,0.06), and it was significantly greater with a more conservative estimate (one event per child per interval; 7.4,±,7.7 vs. 2.6,±,5.4 per 1,000 child-days; P,,0.01). No differences in hospitalizations rates were detected. Conclusion: The infection rates and clinical impact observed for hMPV were comparable to that for RSV in CF children 7,18 years of age. Pediatr Pulmonol. 2007; 42:66,74. © 2006 Wiley-Liss, Inc. [source] Viral and atypical bacterial infections in the outpatient pediatric cystic fibrosis clinic,PEDIATRIC PULMONOLOGY, Issue 12 2006Hanne Vebert Olesen MD Abstract Background Respiratory viral and atypical bacterial infections are associated with pulmonary exacerbations and hospitalisations in cystic fibrosis patients. We wanted to study the impact of such infections on children attending the outpatient clinic. Methods Seventy-five children were followed for 12 months at regular clinic visits. Routine sputum/laryngeal aspirations were tested with PCR for 7 respiratory viruses. Antibodies against C. pneumoniae, M. pneumoniae and B. pertussis were measured every 3,4 months. FEV-1, FEF25,75 and specific airway resistance, "viral" symptoms and bacterial culture were recorded. Results Ninety-seven viral and 21 atypical bacterial infections were found. FEV-1 was significantly reduced during viral infection (,12.5%, p=0.048), with the exception of rhinovirus infection. A small change in FEV-1 (,3%) was seen during atypical bacterial infection (p=0.039). Viral and atypical bacterial infections caused no change in type and frequency of bacterial culture. Positive predictive value of "viral symptoms" was low (0.64%). Eight patients received "unnecessary" antibiotics because of viral symptoms. Conclusions Some viral infections and atypical bacterial infections affect FEV-1 acutely. Viral infections did not precipitate bacterial infection or change of colonisation. Clinical symptoms failed to diagnose viral infection accurately. Routine surveillance for virus or atypical bacteria seems not to be justified in this patient category. Pediatr Pulmonol. 2006; 41:1197,1204. © 2006 Wiley-Liss, Inc. [source] Clinical scoring systems in cystic fibrosisPEDIATRIC PULMONOLOGY, Issue 7 2006Gaudenz M. Hafen MD Abstract The first cystic fibrosis (CF) scoring system was published in 1958. Since then, many other scoring systems were developed. Clinical parameters, details about statistical evaluations, and recent strategic uses of scores were identified. Several similar scores aiming to assess chronic illness severity (Shwachman-Kulczycki score and a modification, Cooperman, Berneze-score and the NIH score) have not been evaluated and are out of date, given the changing natural history of CF. Of the current scoring systems, the modified Shwachman score by Doershuk is perhaps most reliable for describing follow-up studies. Scores designed for acute changes and short-term evaluation were also developed. The modified Huang score may be useful in the prognostic evaluation of patients with end-stage disease. It could also be used for discrimination of adult patients with differing disease severity and for longitudinal evaluation. Scores assessing pulmonary exacerbations could help provide consensus among clinicians regarding the need for intervention. Most of these scores require further evaluation. Although scores could provide an objective measure of disease severity, progression, need for and response to interventions, including value in selecting patients for lung transplantation and as an outcome measure for research studdies, no scoring system can fulfill all these objectives. Nevertheless, there is a need for the development of a modern day longitudinal score that is sensitive, valid and reproducible, to reflect the milder disease status of patients. Pediatr Pulmonol. 2006; 41: 602,617. © 2006 Wiley-Liss, Inc. [source] | ||||||||||