Early Childhood Risk Factors for Decreased FEV1 at Age Six to Seven Years in Young Children with Cystic Fibrosis.
BACKGROUND
There are limited objective measures of the severity of lung disease before children are able to routinely perform spirometry, generally at age 6 years. Identifying risk factors for reduced lung function at age 6 provides opportunities to intervene and slow the progression of cystic fibrosis (CF) lung disease.


OBJECTIVE
To evaluate early childhood predictors of lung function at age 6-7 in a large U.S. CF cohort in the current era of widespread early eradication therapy for Pseudomonas aeruginosa (P. aeruginosa).


METHODS
Participants were children with CF enrolled before age 4 in the Early Pseudomonas Infection Control (EPIC) Observational Study, a multicenter, longitudinal study that enrolled P. aeruginosa-negative children not exceeding 12 years of age. Linear regression was used to estimate the association between potential early childhood risk factors and the best FEV1% predicted at age 6-7 years.


RESULTS
Four hundred and eighty-four children (of 1,797 enrolled in the EPIC Observational Study) met the eligibility criteria for this analysis. Mean (SD) age at enrollment was 2.0 (1.3) years. In a multivariable model adjusted for age at enrollment, the following risk factors were significantly associated with lower mean (95% confidence interval) FEV1% predicted at age 6-7: weight percentile less than 10% during the year of enrollment (-5.3 [-9.1, -1.5]), P. aeruginosa positive during the year of enrollment (-2.8 [-5.7, 0.0]), crackles or wheeze during the year of enrollment (-5.7 [-9.4, -1.9]), mother's education of high school or less (-4.2 [-7.3, -1.2]), and mother smoked during pregnancy (-4.4 [-8.8, 0.1]).


CONCLUSIONS
In this large U.S. cohort, we identified several early childhood risk factors for lower FEV1 at age 6-7 years, most of which are modifiable. Clinical trial registered with www.clinicaltrials.gov (NCT00097773).
1 Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Don B
http://orcid.org/0000-0001-6265-6249
DB
Sanders
2 Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington.
Julia
J
Emerson
3 Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
Clement L
CL
Ren
4 Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond, Richmond, Virginia; and.
Michael S
http://orcid.org/0000-0002-8473-3767
MS
Schechter
2 Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington.
Ronald L
RL
Gibson
5 Department of Pediatrics, University of Arizona, Tucson, Arizona.
Wayne
http://orcid.org/0000-0002-6346-8140
W
Morgan
2 Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington.
Margaret
M
Rosenfeld
D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000188:drug therapy / Q000503:physiopathology; D016014:Linear Models; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology; D015999:Multivariate Analysis; D011552:Pseudomonas Infections / Q000517:prevention & control; D012135:Respiratory Sounds; D012307:Risk Factors; D013147:Spirometry; D014481:United States
D000900:Anti-Bacterial Agents
cystic fibrosis; lung function; microbiology; tobacco smoke pollution