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Cessation of smoke exposure improves pediatric CF outcomes: Longitudinal analysis of CF Foundation Patient Registry
Gabriela R Oates1, Elizabeth Baker1, Joseph M Collaco2
1The University of Alabama at Birmingham, Birmingham, AL, United States.
Insights
Quitting tobacco smoke exposure significantly improves health outcomes for children and adolescents with cystic fibrosis (CF). Cessation reduces pulmonary exacerbations and enhances respiratory and nutritional status, highlighting the importance of smoke-free environments for CF care.
Area of Science:
- Pediatric Pulmonology
- Environmental Health
- Public Health
Background:
- Tobacco smoke exposure is a significant health risk for pediatric cystic fibrosis (CF) patients.
- Assessing the impact of smoke exposure cessation on CF patient outcomes is crucial.
Purpose of the Study:
- To evaluate the association between cessation of tobacco smoke exposure and improved health outcomes in children and adolescents with CF.
- To quantify the benefits of smoke exposure cessation on pulmonary exacerbations, lung function (ppFEV1), and body mass index (BMI) in the CF population.
Main Methods:
- Utilized data from the U.S. CF Foundation Patient Registry (2006-2018) for individuals born 1998-2010.
- Included participants reporting any history of smoke exposure (second-hand, living with a smoker, or self-smoking).
- Employed non-linear and linear mixed models to analyze the effects of ceased exposure on pulmonary exacerbations, ppFEV1, and BMI.
Main Results:
- Cessation of smoke exposure reduced pulmonary exacerbation odds by 17% in the first year, with further 6% reduction per year.
- Associated with a 0.7% increase in ppFEV1 in the first year, plus 0.4% per year.
- Led to a 1% increase in BMI percentile in the first year, plus 0.4% per year.
- Three years of cessation decreased exacerbation probability by 8% and improved ppFEV1 and BMI by 2%.
Conclusions:
- Eliminating smoke exposure is linked to reduced pulmonary exacerbations and better respiratory and nutritional outcomes in pediatric CF patients.
- Prioritizing smoking cessation and exposure prevention is essential in managing cystic fibrosis care for children and adolescents.
Background:
Tobacco smoke exposure is a major risk factor for the health of children and adolescents with CF. In this study, we assess whether cessation of smoke exposure is associated with improved outcomes in this population.
Methods:
We used annualized and encounter-based data from the U.S. CF Foundation Patient Registry (2006-2018) on all individuals born 1998-2010. The analytical sample included those who ever reported second-hand smoke exposure (daily or weekly), ever lived with a smoker, or ever reported smoking themselves. We used non-linear mixed models for pulmonary exacerbations and linear mixed models for ppFEV1 and BMI as a function of ceased exposure.
Results:
The sample included 3,633 individuals contributing 19,629 person-years. Cessation of smoke exposure reduced the odds of a pulmonary exacerbation in 12 months by 17% (OR 0.83, p < 0.001) in the first year of cessation, with an additional 6% decrease (OR 0.94, p = 0.003) for each additional year of cessation. Cessation was associated with improvements in ppFEV1 and BMI: 0.7% ppFEV1 increase (p < 0.001) in the first year of cessation and 0.4% increase (p = 0.001) for each additional year of cessation; 1% increase in BMI percentile (p < 0.001) in the first year of cessation plus 0.4% increase (p = 0.009) for each additional year. Three years of cessation reduce the predicted probability of a pulmonary exacerbation in 12 months by 8% and improve ppFEV1 and BMI by 2%.
Conclusion:
Eliminating smoke exposure may reduce pulmonary exacerbations and improve respiratory and nutritional outcomes in children and adolescents with CF. Both smoking cessation and exposure prevention should be prioritized in pediatric CF care.
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