title: Early respiratory infection is associated with reduced spirometry in children with cystic fibrosis.
abstract: BACKGROUND
  Pulmonary inflammation, infection, and structural lung disease occur early in life in children with cystic fibrosis.
  
  
  OBJECTIVE
  We hypothesized that the presence of these markers of cystic fibrosis lung disease in the first 2 years of life would be associated with reduced lung function in childhood.
  
  
  METHODS
  Lung function (forced expiratory volume in the first three-quarters of a second [FEV0.75], FVC) was assessed in individuals with cystic fibrosis diagnosed after newborn screening and healthy subjects during infancy (0-2 yr) and again at early school age (4-8 yr). Individuals with cystic fibrosis underwent annual bronchoalveolar lavage fluid examination, and chest computed tomography. We examined which clinical outcomes (pulmonary inflammation, infection, structural lung disease, respiratory hospitalizations, antibiotic prophylaxis) measured in the first 2 years of life were associated with reduced lung function in infants and young children with cystic fibrosis, using a mixed effects model.
  
  
  RESULTS
  Children with cystic fibrosis (n = 56) had 8.3% (95% confidence interval [CI], -15.9 to -6.6; P = 0.04) lower FEV0.75 compared with healthy subjects (n = 18). Detection of proinflammatory bacterial pathogens (Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, Aspergillus species, Streptococcus pneumoniae) in bronchoalveolar lavage fluid was associated with clinically significant reductions in FEV0.75 (ranging between 11.3 and 15.6%).
  
  
  CONCLUSIONS
  The onset of lung disease in infancy, specifically the occurrence of lower respiratory tract infection, is associated with low lung function in young children with cystic fibrosis. Deficits in lung function measured in infancy persist into childhood, emphasizing the need for targeted therapeutic interventions in infancy to maximize functional outcomes later in life.
authors.affiliation: 1 Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Ramsey
authors.forename: Sarath
authors.initials: S
authors.lastname: Ranganathan
authors.forename: Judy
authors.initials: J
authors.lastname: Park
authors.forename: Billy
authors.initials: B
authors.lastname: Skoric
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Adams
authors.forename: Shannon J
authors.initials: SJ
authors.lastname: Simpson
authors.forename: Roy M
authors.initials: RM
authors.lastname: Robins-Browne
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Franklin
authors.forename: Nick H
authors.initials: NH
authors.lastname: de Klerk
authors.forename: Peter D
authors.initials: PD
authors.lastname: Sly
authors.forename: Steve M
authors.initials: SM
authors.lastname: Stick
authors.forename: Graham L
authors.initials: GL
authors.lastname: Hall
mesh_terms: D000367:Age Factors; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012307:Risk Factors; D013147:Spirometry; D014797:Vital Capacity / Q000502:physiology*
keywords: bronchoalveolar lavage; infant; longitudinal; lung function; pulmonary infection