Lung function comparison between two decades in cystic fibrosis children: A single centre study
Gloria Tridello1, Sonia Volpi1, Baroukh M Assael1
1Cystic Fibrosis Center, Verona, Italy.
Insights
This study found improved lung function in cystic fibrosis (CF) patients diagnosed via newborn screening over two decades. These findings highlight the impact of modern CF therapies on patient outcomes.
Area of Science:
- Pulmonology
- Pediatrics
- Genetics
Background:
- Cystic Fibrosis (CF) is a genetic disorder affecting multiple organs.
- Neonatal screening allows for early diagnosis and intervention.
- Therapeutic advancements have significantly impacted CF patient care.
Purpose of the Study:
- To compare pulmonary function decline in two CF patient cohorts born in different decades.
- To assess the impact of neonatal screening and evolving treatments on CF outcomes.
- To identify a potential cohort effect in CF patient lung function.
Main Methods:
- Retrospective analysis of CF patients born between 1979-1984 (Cohort 1) and 1991-1996 (Cohort 2).
- Comparison of pulmonary function decline (FEV1%, FEF 25-75%) from ages 10 to 15.
- Statistical analysis using a linear mixed model approach to evaluate cohort differences.
Main Results:
- Significant amelioration in pulmonary function decline observed in Cohort 2 compared to Cohort 1 (P < 0.001 for both FEV1% and FEF 25-75%).
- Mean absolute decrement of FEV1% was 9.2 in Cohort 1 vs. 0.6 in Cohort 2.
- Mean decrement of FEF 25-75% was 16.3 in Cohort 1 vs. 1.3 in Cohort 2.
Conclusions:
- Pulmonary function has markedly improved in young CF patients over a decade.
- This improvement correlates with the introduction of key therapies like dornase alfa, tobramycin, and hypertonic saline.
- This study provides evidence of a cohort effect in CF patients diagnosed through neonatal screening.
Objectives:
The purpose of this study was to compare two cohorts of cystic fibrosis (CF) patients born and treated in two different decades, diagnosed through a CF neonatal screening program.
Methodology:
We compared pulmonary function decline from 10 to 15 years of age in patients with cystic fibrosis born between 1979 and 1984 (Cohort 1) and between 1991 and 1996 (Cohort 2). Forced expiratory volume in 1 sec (FEV1%) and forced expiratory flow from 25% to 75% (FEF 25-75%) were analyzed by a linear mixed model approach. The differences between the two cohorts were estimated and the overall cohort effect was tested.
Results:
Ninety-two patients (51 males, 41 females) fulfilled the selection criteria. Pancreatic insufficiency and CF related diabetes were present in 91% and 20% of patients, respectively. The mean absolute decrement of FEV1% was 9.2 (standard deviation [SD] 11.2) in Cohort 1 and 0.6 (SD 10.4) in Cohort 2 (P < 0.001). The mean decrement of FEF 25-75% was 16.3 (SD 19.5) in Cohort 1 and 1.3 (SD 16.8) in Cohort 2 (P < 0.001) and the Pseudomonas aeruginosa (Pa) colonization was 28% and 15% respectively (P = 0.1).
Conclusions:
Our results show that pulmonary function has clearly ameliorated over a decade in young CF patients, in a period during which several significant therapeutic changes have been introduced, such as dornase alfa, tobramycin and hypertonic saline. To our knowledge this is the first study showing a cohort effect in patients diagnosed after neonatal screening.
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