A study in young children with cystic fibrosis (CF) shows that low chest radiograph scores are associated with more frequent pulmonary exacerbations, and the use of antibiotics is beneficial when respiratory symptoms increase.
Although it’s been established that pulmonary exacerbations lead to a decline in lung function in older children and adults with CF, the effects in younger children were not fully understood.
In the study, “Pulmonary exacerbations and clinical outcomes in a longitudinal cohort of infants and preschool children with cystic fibrosis,” published in the journal BMC Pulmonary Medicine, researchers investigated the frequency and clinical impact of pulmonary exacerbations in very young CF children.
The study included 30 children with CF ages 3 months to 4 years; 13 were girls and 17 were boys. The follow-up time period was two years. Pulmonary exacerbations were determined through a diagnosis by the primary CF provider and the use of antibiotics for respiratory symptoms. Pulmonary function was assessed at age 7 in a subset of children, using the lung function tools forced expiratory volume (FEV) and forced vital capacity (FVC).
At least one pulmonary exacerbation was reported in 90 percent of children over the two-year period, with a median of two exacerbations per child. This result was independent of age, gender, weight, height, and the presence of Staphylococcus aureus bacteria at the time of enrollment. Eight children required hospitalization for respiratory symptoms.
Chest radiographs were assessed at the start and at the end of the study.
Results showed that patients who had better chest radiograph scores had fewer pulmonary exacerbations during the study. Methicillin-sensitive S. aureus (MSSA) and Haemophilus influenzae were the most common pathogens identified on oropharyngeal cultures.
No link was detected between the frequency of pulmonary exacerbations and lower FEV and FVC values in the 7-year-old children, although the team emphasized that “spirometry [a test to assess lung function] in this age group may not be a sensitive marker of mild lung disease and disease progression.”
Overall, the results show that chest radiographs can be used as a tool to obtain an indication of the possible future risk of pulmonary exacerbation. The results also “suggest that frequent use of antibiotics in patients with increased respiratory symptoms may be beneficial,” the researchers wrote.
Still, the team emphasized that additional studies are needed to better understand the “impact of pulmonary exacerbations, oral antibiotic treatment and the effect on lung function.”
The study provides data about chest X-ray scores, the frequency of pulmonary events, and the relationship between exacerbations, the use of antibiotics, and lung function that could be used for analyses in larger studies, the researchers added.
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