Trends in the use of routine therapies in cystic fibrosis: 1995-2005.
Many therapies are used to treat manifestations of cystic fibrosis (CF). Trends in routine therapy use in Epidemiologic Study of Cystic Fibrosis patients were studied from 1995 to 2005. Patients (15,087) were assessed in 1995; 12,778 in 2005. Observed differences in therapy use of ≥2% were statistically significant at P < 0.001. Comparing the 1995 and 2005 populations, mean age was 13.9 versus 15.5 years; weight-for-age percentile was 30.3 versus 36.9; and mean forced expiratory volume in 1 sec (FEV(1)) was 73.7% (n = 7065) versus 78.7% (n = 7867) predicted. Use of several therapies increased, including airway clearance (69.9-89.6%), inhaled bronchodilators (72.0-84.0%), dornase alfa (44.8-67.2%), inhaled corticosteroids (16.0-49.3%), inhaled antibiotics (6.5-43.1%), oral nutritional supplements (18.3-24.5%), and insulin/oral hypoglycemic agents (4.9-10.2%). Use of mast cell stabilizers (from 22.0% to 5.3%) and oral bronchodilators (from 10.4% to 1.5%) decreased. Less dramatic changes occurred for pancreatic enzymes (92.6-91.0%), oral nonquinolone antibiotics (44.7-39.8%), oral corticosteroids (7.8-5.2%), mucolytics (4.4-2.5%), NSAIDs/high-dose ibuprofen (3.6-3.3%), enteral nutrition (5.2% vs. 8.2%), and oxygen (4.7-4.5%). Therapies not tracked in 1995 were evident in 2005, including oral macrolide antibiotics (33.8%), leukotriene inhibitors/antagonists (10.8%), and inhaled hypertonic saline (2.6%). Routine therapies were generally used more often by older patients and those with lower FEV(1). Notable increases in use of therapies, particularly of inhaled therapies, suggest that overall patient treatment burden must have risen correspondingly.
Konstan
Michael W
MW
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. michael.konstan@case.edu
VanDevanter
Donald R
DR
Rasouliyan
Lawrence
L
Pasta
David J
DJ
Yegin
Ashley
A
Morgan
Wayne J
WJ
Wagener
Jeffrey S
JS
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000628:therapy*; D003850:Deoxyribonuclease I / Q000627:therapeutic use; D019587:Dietary Supplements / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000639:trends*; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005100:Expectorants / Q000627:therapeutic use; D005541:Forced Expiratory Volume; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008137:Longitudinal Studies; D009656:North America / Q000453:epidemiology; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001993:Bronchodilator Agents; D005100:Expectorants; D007004:Hypoglycemic Agents; D020024:Leukotriene Antagonists; D012462:Saline Solution, Hypertonic; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I