Early Childhood Risk Factors for Decreased FEV1 at Age Six to Seven Years in Young Children with Cystic Fibrosis
Don B Sanders1, Julia Emerson2, Clement L Ren3
11 Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
Identifying early childhood risk factors for reduced lung function in cystic fibrosis (CF) is crucial. Low weight, Pseudomonas aeruginosa infection, respiratory symptoms, lower maternal education, and maternal smoking during pregnancy are linked to poorer lung function at age 6-7.
Area of Science:
- Pediatric Pulmonology
- Cystic Fibrosis Research
- Respiratory Health
Background:
- Objective measures of lung disease severity in young children with cystic fibrosis (CF) are limited before spirometry is feasible (around age 6).
- Early identification of risk factors for reduced lung function can inform interventions to slow CF lung disease progression.
- Current research considers the impact of widespread early Pseudomonas aeruginosa eradication therapies.
Purpose of the Study:
- To identify early childhood predictors of lung function at age 6-7 years in a large U.S. cohort of children with CF.
- To assess these predictors in the context of current early Pseudomonas aeruginosa treatment strategies.
Main Methods:
- Analysis of data from the Early Pseudomonas Infection Control (EPIC) Observational Study, a multicenter, longitudinal study.
- Inclusion criteria: children with CF enrolled before age 4, negative for Pseudomonas aeruginosa at enrollment, and under 12 years of age.
- Linear regression used to correlate early childhood risk factors with best FEV1% predicted at age 6-7 years.
Main Results:
- Four hundred eighty-four children met eligibility criteria.
- Significant risk factors for lower FEV1% predicted at age 6-7 included: weight percentile <10% at enrollment, Pseudomonas aeruginosa positivity during the year of enrollment, crackles or wheeze during the year of enrollment, maternal education (high school or less), and maternal smoking during pregnancy.
- Specific associations quantified, e.g., maternal smoking associated with a -4.4% lower FEV1% predicted.
Conclusions:
- Several early childhood factors, many modifiable, are associated with reduced FEV1 at age 6-7 in children with CF.
- Findings highlight potential targets for early intervention to improve long-term lung health in CF.
- The study was registered with ClinicalTrials.gov (NCT00097773).
Rationale:
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.
Objectives:
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.
Measurements And Main 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).
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