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Published on: January 22, 2021
Change in lung clearance index with microbiological status in children with cystic fibrosis
Katarzyna Walicka-Serzysko1,2, Magdalena Postek1,2, Justyna Milczewska1,2
1Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.
Insights
Lung clearance index (LCI) in cystic fibrosis patients is linked to specific infections. Chronic Aspergillus fumigatus and Pseudomonas aeruginosa increase LCI, highlighting the importance of early pathogen eradication for lung health.
Area of Science:
- Respiratory Medicine
- Pediatric Pulmonology
- Clinical Microbiology
Background:
- Cystic Fibrosis (CF) lung disease progression is significantly impacted by bacterial infections, particularly Gram-negative bacteria.
- Pulmonary function decline in CF often begins in early childhood.
- Lung clearance index (LCI) is a sensitive marker for small airway disease in CF, potentially more so than FEV1.
Purpose of the Study:
- To examine the relationship between the microbiological status of pediatric cystic fibrosis patients and their lung clearance index (LCI).
- To compare LCI with traditional spirometry measures (FEV1, FVC) in relation to various CF-related infections.
- To assess the impact of different pathogens, including Staphylococcus aureus, Pseudomonas aeruginosa, and Aspergillus fumigatus, on LCI.
Main Methods:
- A cohort of 136 pediatric CF patients (aged 5-18) were enrolled over one year.
- Patients were categorized based on microbiological findings: Staphylococcus aureus, Pseudomonas aeruginosa (new, intermittent, chronic), Aspergillus fumigatus, or no pathogenic flora.
- Lung clearance index (LCI) was measured using the multiple breath washout (MBW) technique, alongside spirometry (FEV1, FVC).
Main Results:
- Patients with Aspergillus fumigatus infections showed significantly higher LCI compared to those with normal flora (P < 0.05).
- Significant differences in LCI were observed between patients with chronic Pseudomonas aeruginosa infection and those with first-time infection (P < 0.05).
- Distinct LCI values were noted between chronic Pseudomonas aeruginosa infected patients with FEV1 > 70% and FEV1 < 70% (P < 0.05).
Conclusions:
- Lung clearance index (LCI) is demonstrably associated with the microbiological landscape in cystic fibrosis patients.
- Chronic lung infections, specifically by Aspergillus fumigatus and Pseudomonas aeruginosa, correlate with elevated LCI.
- Timely eradication of pathogenic microbial flora is crucial for maintaining lower LCI and potentially mitigating small airway disease progression in CF.
Abstract:
The impact of infections caused by bacteria, especially Gram-negative, on the progression of lung disease in cystic fibrosis is well established. Decline in pulmonary function commence already at early age. In this group of patients, the lung clearance index seems to be a better marker than FEV1 allowing non-invasive monitoring of changes in small airways. The aim of this study was to investigate the association between the microbiological status and LCI derived from multiple breath washout (MBW) technique as well as FEV1 and FVC in children suffering from cystic fibrosis. Over the 1-year recruitment period, 136 CF patients aged 5-18 with: Staphylococcus aureus (n-27), Pseudomonas aeruginosa (first time (n-27), intermittent (n-9), and chronic (34) infection), Aspergillus fumigatus (n-6) and without pathogenic flora (n-33) were included in the study. Patients had performed a spirometry and MBW test during the visit at outpatient clinic. The study showed that the lung clearance index in patients infected with Aspergillus fumigatus was significantly higher (P < 0.05) than in those with normal throat flora. There was also statistically significant differences in the lung clearance index obtained in subjects with chronic Pseudomonas aeruginosa infection and those with first Pseudomonas aeruginosa infection (P < 0.05). Furthermore, significant statistical differences (P < 0.05) were observed between the groups of patients with chronic Pseudomonas aeruginosa infection FEV1 > 70% and FEV1 < 70%. In conclusion, LCI was associated with microbiological status of CF patients. Chronic lung infections, especially Aspergillus fumigatus and Pseudomonas aeruginosa, were associated with increased LCI. Early eradication of pathological flora positively affects the maintenance of lower LCI.
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