title: Alternative outcomes for the multiple breath washout in children with CF.
abstract: BACKGROUND
  The lung clearance index (LCI) measured by multiple-breath washout (MBW) has been proposed as an outcome for clinical trials; however, MBW is time consuming and LCI can be affected by breathing pattern. We aimed to evaluate moment ratios and abbreviated LCI in school-aged children with mild-to-moderate CF lung disease.
  
  
  METHODS
  Using existing data from three studies we assessed the sensitivity of moment ratios and abbreviated LCIs to (i) detect mild-to-moderate CF lung disease and (ii) detect treatment effects after 4 weeks of hypertonic saline or dornase alfa inhalation. MBW was measured by respiratory mass spectrometry using 4% ""sulphur hexafluoride as a tracer gas.
  
  
  RESULTS
  Compared to the traditional LCI, moment ratios and abbreviated LCIs were similarly sensitive to detect CF lung disease. Moment ratios consistently demonstrated treatment effects, whereas abbreviated LCIs were less sensitive.
  
  
  CONCLUSIONS
  Both moment ratios and abbreviated LCI are suitable to differentiate health from disease. Sensitivity is decreased for abbreviated LCIs in interventional studies in mild CF lung disease.
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada; University of Toronto, Canada. Electronic address: Sanja.Stanojevic@sickkids.ca.
authors.forename: Sanja
authors.initials: S
authors.lastname: Stanojevic
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.
authors.forename: Renee
authors.initials: R
authors.lastname: Jensen
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.
authors.forename: Dasiga
authors.initials: D
authors.lastname: Sundaralingam
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.
authors.forename: Juliana Giraldo
authors.initials: JG
authors.lastname: Salazar
authors.affiliation: University Children's Hospital Bern, 3010 Bern, Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Yammine
authors.affiliation: University Children's Hospital Bern, 3010 Bern, Switzerland.; University Children's Hospital Zurich, 8032 Zurich, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Singer
authors.affiliation: University Children's Hospital Bern, 3010 Bern, Switzerland.; University Children's Hospital Basel, UKBB, 4031 Basel, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Latzin
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; University of Toronto, Canada.
authors.forename: Reshma
authors.initials: R
authors.lastname: Amin
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada; University of Toronto, Canada.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Subbarao
authors.affiliation: Department of Pediatrics, Central Hospital, Skövde, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Gustafsson
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; Physiology and Experimental Medicine, Research Institute, Hospital for Sick Children, Toronto, Canada; University of Toronto, Canada.
authors.forename: Felix
authors.initials: F
authors.lastname: Ratjen
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D001944:Breath Tests / Q000379:methods*; D002648:Child; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003850:Deoxyribonuclease I / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011994:Recombinant Proteins / Q000627:therapeutic use; D012129:Respiratory Function Tests; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012680:Sensitivity and Specificity
chemical_list: D011994:Recombinant Proteins; D012462:Saline Solution, Hypertonic; D003850:Deoxyribonuclease I; C568813:dornase alfa
keywords: Clinical trials; Cystic fibrosis; Multiple breath washout