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Reversible airway obstruction in cystic fibrosis
Insights
Many children with cystic fibrosis (CF) show improved lung function after salbutamol if they are atopic. Atopy and allergic bronchopulmonary aspergillosis are common in CF patients with reversible airways.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Cystic fibrosis (CF) affects lung function, and airway hyperresponsiveness is a recognized complication.
- Atopy, characterized by allergic sensitization, is prevalent in CF patients and may influence disease progression.
Purpose of the Study:
- To investigate the relationship between atopy, airway reversibility, and allergic bronchopulmonary aspergillosis (ABPA) in children with CF.
- To assess the impact of atopy on lung function parameters in pediatric CF patients.
Main Methods:
- Evaluated airway reversibility using spirometry (forced expiratory volume in one second and forced vital capacity) after salbutamol inhalation in 48 children with CF.
- Assessed atopy through skin prick tests and measured serum IgE levels.
- Investigated the prevalence of sensitization to common allergens, including Aspergillus fumigatus, and the presence of serum precipitins to A. fumigatus and pancreatin.
Main Results:
- Twenty-nine percent of children with CF demonstrated significant airway reversibility.
- Children with reversible airways were significantly more likely to be atopic and have higher serum IgE levels.
- Half of the children with reversible airways developed or had clinical signs of ABPA.
- Non-atopic children exhibited significantly better spirometry results compared to atopic children.
- Serum precipitins to pancreatin were common (71%) but did not correlate with atopy or airway reversibility.
Conclusions:
- Atopy is strongly associated with airway reversibility and higher serum IgE in children with CF.
- Airway reversibility in pediatric CF patients may indicate an increased risk for developing allergic bronchopulmonary aspergillosis.
- Atopic status significantly impacts lung function in children with cystic fibrosis.
Abstract:
Fourteen (29%) of 48 children with cystic fibrosis had a greater than 15% improvement in forced expiratory volume in one second, or in forced vital capacity after inhalation of salbutamol. All these children were atopic (one or more positive prick tests) and had a significantly higher mean serum IgE than either non-atopic subjects or those atopic subjects without airways reversibility (p less than 0.02). Half of those with airways reversibility had or subsequently developed the clinical picture of allergic bronchopulmonary aspergillosis. Of the whole group 81% were atopic, of whom 77% had a positive reaction to A fumigatus, 64% to housedust, and 56% each to grass pollen and cat hair. Children who were not atopic had significantly better spirometry (p greater than 0.05) than those who were. Children with skin hypersensitivity to A fumigatus had identical spirometry to those who were atopic without reactivity to A fumigatus. Serum precipitins to A fumigatus were present in 48%. Serum precipitins to pancreatin were present in 71%, but the presence of these precipitins did not correlate with atopy, airways reversibility, or serum IgE.