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Relationship between FEV1 and peak oxygen uptake in children with cystic fibrosis
Paul Pianosi1, John LeBlanc, Anthony Almudevar
1Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. pianosi.paolo@mayo.edu
Insights
Peak oxygen uptake (peak VO2) declines with lung function (FEV1) in children with cystic fibrosis, especially in older patients and those with FEV1 below 80%. Younger children may see stable or improved peak VO2.
Area of Science:
- Pediatric Pulmonology
- Cardiorespiratory Physiology
- Cystic Fibrosis Research
Background:
- Lung function decline is characteristic in cystic fibrosis (CF).
- The relationship between lung function and cardiorespiratory fitness, specifically peak oxygen uptake (peak VO2), over time in pediatric CF patients is not well-defined by cross-sectional data.
- Understanding this longitudinal relationship is crucial for managing CF patients.
Purpose of the Study:
- To investigate the longitudinal relationship between changes in forced expiratory volume in 1 second (FEV1) and peak oxygen uptake (peak VO2) in children with cystic fibrosis.
- To identify predictors of change in peak VO2 over time within this population.
Main Methods:
- A 5-year longitudinal study involving 28 children (aged 8-17 years) with cystic fibrosis.
- Annual ergometer testing was performed to measure peak VO2.
- Mixed-effects modeling was used to analyze within-patient changes in peak VO2 and FEV1.
- Correlation between FEV1 and peak VO2 was assessed, particularly in relation to FEV1 thresholds (80% predicted).
Main Results:
- An average annual decline of 2.7% in predicted FEV1 was observed.
- Peak VO2 declined in 70% of patients, with an average decrease of 1.9 ml x min(-1) x kg(-1) per year.
- Decline in peak VO2 was more pronounced in older children; younger children showed stable or improving peak VO2.
- A strong correlation between declining FEV1 and falling peak VO2 was evident in patients with FEV1 <80% predicted.
- Peak VO2 remained stable in patients with FEV1 >80% predicted.
Conclusions:
- Peak oxygen uptake (peak VO2) in pediatric cystic fibrosis patients is influenced by both age and FEV1.
- While younger children may maintain or improve peak VO2, older children, particularly those with FEV1 below 80% predicted, experience a decline.
- Longitudinal assessment reveals a significant correlation between declining lung function and cardiorespiratory fitness in CF.
Abstract:
Cross-sectional data do not truly convey the manner in which declining lung function affects peak oxygen uptake (peak VO2) within a given patient with cystic fibrosis. We hypothesized that there would be a concomitant decline in peak VO2 with FEV1 over time. Twenty-eight children aged 8-17 years with cystic fibrosis performed annual ergometer tests over a 5-year period to determine peak VO2 and within-patient predictors of change in peak VO2. Analysis was done using a mixed-effects model. During the study period, the annual decline in FEV1 averaged 2.7% of the predicted value per year. Peak VO2 fell during the observation period in 70% of patients, with an average annualized decline of 1.9 ml x min(-1) x kg(-1). This rate of decline was greater in older children in contrast to younger children, some of whom had an improvement in peak VO2 over the first few years, consistent with growth and maturation. There was no difference in this rate of decline between sexes, but girls started with a slightly lower peak VO2 (37.9 vs. 45.1 ml x min(-1) x kg(-1)). In patients with FEV1 <80% predicted, declining FEV1 was highly correlated with falling peak VO2, whereas it remained stable over 4-5 years in patients whose FEV1 was >80% predicted and remained in that range. We conclude that peak VO2 remains stable or rises slightly over time in younger patients, while it shows a downward trend in older children with CF, particularly once FEV1 falls below 80% predicted. Peak VO2 is correlated with FEV1 during childhood in patients with cystic fibrosis, and both FEV1 and age influence peak VO2.
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