Return of FEV1 after pulmonary exacerbation in children with cystic fibrosis

• DOI: 10.1002/ppul.21117
• Publication Date: 2010-01-06T20:22:17Z
• Authors: Don B. Sanders; Lucas R. Hoffman; Julia Emerson; Ronald L. Gibson; Margaret Rosenfeld; Gregory J. Redding; Christopher H. Goss
• Keywords: Male; Washington; Adolescent; Cystic Fibrosis; Bacterial Infections; Severity of Illness Index; 3. Good health; Anti-Bacterial Agents; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Forced Expiratory Volume; Disease Progression; Humans; Female; Child

AbstractRationaleLung function (FEV1) generally improves during treatment of pulmonary exacerbations in patients with cystic fibrosis (CF). However, it is unclear how often return to previous baseline FEV1 is achieved.Objectives(1) To determine the proportion of pediatric patients with CF treated for a pulmonary exacerbation who fail to recover to baseline FEV1 and (2) to identify factors associated with this failure.MethodsWe performed a case–control analysis of patients from a single pediatric CF center admitted for their first pulmonary exacerbation in 2001–2006. Patients were considered to have recovered to baseline FEV1 if their best FEV1 within the 3 months following treatment was ≥95% of the best FEV1 during the 6 months prior to treatment. Logistic regression was used to estimate associations between clinical characteristics and failure to regain baseline FEV1.ResultsOf 104 patients, 24 (23.1%) did not recover to baseline FEV1. The adjusted odds ratio of failure to recover to baseline FEV1 was 1.49 (95% confidence interval [CI] 1.20, 1.86) for every 5% greater decline in FEV1 from baseline to admission. In exploratory analyses, the adjusted odds ratios for the failure to recover to baseline were also significantly higher for patients who were evaluated in our CF clinic more frequently between the baseline measurement and admission, were younger, or were insured by Medicaid.ConclusionsApproximately one in four patients with CF failed to recover to baseline lung function after a pulmonary exacerbation despite treatment with intravenous antibiotics. Failure to recover to baseline was associated with the degree of decline in FEV1 that had occurred prior to hospital admission, suggesting opportunities for earlier intervention to improve lung function outcomes. Additional studies are needed to determine how the failure to recover to baseline affects subsequent FEV1 decline. Pediatr Pulmonol. 2010; 45:127–134. © 2010 Wiley‐Liss, Inc.