Pulmonary exacerbations and parent-reported outcomes in children <6 years with cystic fibrosis.
Pulmonary exacerbations (PEs) are used as clinical endpoints in infants and preschool children with cystic fibrosis (CF); however, their characteristics and impact in this age range are poorly understood. We used data from the Infant Study of Inhaled Saline, a multicenter trial of inhaled hypertonic versus isotonic saline, to describe PEs in children with CF <6 years and evaluate associations between PEs and parent-reported outcomes assessed by a weekly parent questionnaire (10 items) and three scales of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), and other participant characteristics. There were 659 PEs among 253 of the 321 ISIS participants (mean age 2.3 years) during 287 participant-years follow-up. Of the 659 PEs, 636 (97%) were treated with oral and 45 (7%) with IV antibiotics (not mutually exclusive). Among 222 participants with PEs who had completed parent questionnaires during a PE and at baseline, 9 of the 10 symptoms were each present in a statistically significantly higher proportion of participants during a PE than at baseline. Lower (worse) baseline Respiratory Symptom and Physical Functioning CFQ-R scores were significantly associated with higher PE rate: rate ratio 1.08 (95%CI: 1.02, 1.14) and 1.21 (1.07, 1.36) per 10 point lower score in respective scale. A higher PE rate was also significantly associated with worse CFQ-R Respiratory Symptom and Physical Functioning scores at the end of the study, adjusted for baseline scores. Though most PEs did not require IV antibiotics, PEs appeared to have a negative impact on parent-reported health outcomes in infants and preschoolers with CF. Pediatr Pulmonol. 2015; 50:236-243. © 2014 Wiley Periodicals, Inc.
University of Washington, Seattle, Washington.
Lyndia C
LC
Brumback
University of Washington, Seattle, Washington.
Arthur
A
Baines
Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Felix
F
Ratjen
Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana.
Stephanie D
SD
Davis
University of Washington, Seattle, Washington.
Stephen L
SL
Daniel
University of Miami, Coral Gables, Florida.
Alexandra L
AL
Quittner
Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
Margaret
M
Rosenfeld
cystic fibrosis questionnaire-revised; infants; pulmonary exacerbations; respiratory symptoms