title: Impact of inhaled corticosteroids on the risk of early Pseudomonas aeruginosa acquisition in cystic fibrosis.
abstract: OBJECTIVE
  To investigate the role of inhaled corticosteroids (IC) on the risk of Pseudomonas aeruginosa acquisition before the age of 10 y in cystic fibrosis (CF) patients.
  
  
  METHODS
  For each subject the cumulative dose kg(-1) of IC received for each year of age was calculated until the end of follow-up. The age at CF diagnosis, the nutritional status (NS) and the number of respiratory exacerbations (RE) were used as surrogate measures for the severity of CF.
  
  
  RESULTS
  A total of 83 patients (40 M, 43 F) entered the study. Their median length of follow-up was 4.4 y, for a total of 386 person-years at risk. Twenty-three patients acquired P. aeruginosa at a median age of 4.6 y (range 0.4-9.9 y). The estimated survival without P. aeruginosa acquisition was 65% at 10 y of age. The effect of different risk factors (IC, NS, RE and age at CF diagnosis) on the probability of P. aeruginosa acquisition was evaluated: none of them was significantly associated with the risk of P. aeruginosa acquisition. In particular, patients receiving very high cumulative doses of IC (4th quartile) had a non-significantly increased risk of P. aeruginosa acquisition compared with those receiving low doses of IC (1st quartile) (hazard ratio = 1.73, 95% confidence limits 0.40-7.38).
  
  
  CONCLUSIONS
  This retrospective study was not able to demonstrate any role of IC in increasing the risk of P. aeruginosa acquisition. This complication seems to occur at a constant pace that is independent of CF severity and age. Prospective multi-institutional randomized studies are needed to investigate the effects of high-dose IC in CF patients.
authors.affiliation: Department of Pediatrics, University of Genoa, G. Gaslini Children's Hospital, Genoa, Italy. lauraminicucci@ospedale-gaslini.ge.it
authors.forename: L
authors.initials: L
authors.lastname: Minicucci
authors.forename: G
authors.initials: G
authors.lastname: Severi
authors.forename: L
authors.initials: L
authors.lastname: Cresta
authors.forename: A
authors.initials: A
authors.lastname: Giannattasio
authors.forename: R
authors.initials: R
authors.lastname: Lorini
authors.forename: R
authors.initials: R
authors.lastname: Haupt
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000145:classification / Q000150:complications* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D011552:Pseudomonas Infections / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D011550:Pseudomonas aeruginosa / Q000472:pathogenicity; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones