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Structural determinants of long-term functional outcomes in young children with cystic fibrosis

Lidija Turkovic, Daan Caudri, Tim Rosenow, Oded Breuer, Conor Murray, Harm A.W.M. Tiddens, Fiona Ramanauskas, Sarath C. Ranganathan, Graham L. Hall, Stephen M. Stick on behalf of AREST CF
European Respiratory Journal 2020 55: 1900748; DOI: 10.1183/13993003.00748-2019
Lidija Turkovic
1Telethon Kids Institute, Perth, Australia
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  • For correspondence: lidijat@gmail.com
Daan Caudri
1Telethon Kids Institute, Perth, Australia
2Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Australia
3Dept of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
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Tim Rosenow
1Telethon Kids Institute, Perth, Australia
4Centre for Child Health Research, University of Western Australia, Perth, Australia
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  • ORCID record for Tim Rosenow
Oded Breuer
1Telethon Kids Institute, Perth, Australia
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Conor Murray
5Dept of Diagnostic Imaging, Princess Margaret Hospital, Perth, Australia
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Harm A.W.M. Tiddens
3Dept of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
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Fiona Ramanauskas
6Murdoch Children's Research Institute, Parkville, Australia
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Sarath C. Ranganathan
6Murdoch Children's Research Institute, Parkville, Australia
7Dept of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Australia
8Dept of Pediatrics, University of Melbourne, Parkville, Australia
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Graham L. Hall
1Telethon Kids Institute, Perth, Australia
9School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Stephen M. Stick
1Telethon Kids Institute, Perth, Australia
2Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Australia
4Centre for Child Health Research, University of Western Australia, Perth, Australia
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Abstract

Background Accelerated lung function decline in individuals with cystic fibrosis (CF) starts in adolescence with respiratory complications being the most common cause of death in later life. Factors contributing to lung function decline are not well understood, in particular its relationship with structural lung disease in early childhood. Detection and management of structural lung disease could be an important step in improving outcomes in CF patients.

Methods Annual chest computed tomography (CT) scans were available from 2005 to 2016 as a part of the AREST CF cohort for children aged 3 months to 6 years. Annual spirometry measurements were available for 89.77% of the cohort (167 children aged 5–6 years) from age 5 to 15 years through outpatient clinics at Perth Children's Hospital (Perth, Australia) and The Royal Children's Hospital in Melbourne (Melbourne, Australia) (697 measurements, mean±sd age 9.3±2.1 years).

Results Children with a total CT score above the median at age 5–6 years were more likely to have abnormal forced expiratory volume in 1 s (FEV1) (adjusted hazard ratio 2.67 (1.06–6.72), p=0.037) during the next 10 years compared to those below the median chest CT score. The extent of all structural abnormalities except bronchial wall thickening were associated with lower FEV1 Z-scores. Mucus plugging and trapped air were the most predictive sub-score (adjusted mean change −0.17 (−0.26 – −0.07) p<0.001 and −0.09 (−0.14 – −0.04) p<0.001, respectively).

Discussion Chest CT identifies children at an early age who have adverse long-term outcomes. The prevention of structural lung damage should be a goal of early intervention and can be usefully assessed with chest CT. In an era of therapeutics that might alter disease trajectories, chest CT could provide an early readout of likely long-term success.

Abstract

Structural lung changes identified on a chest CT scan in children with cystic fibrosis under 6 years of age can identify those at risk of adverse long-term outcomes http://bit.ly/39QH5jv

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Conflict of interest: L. Turkovic has nothing to disclose.

  • Conflict of interest: D. Caudri has nothing to disclose.

  • Conflict of interest: T. Rosenow reports grants from National Health and Medical Research Council, during the conduct of the study. In addition, Dr. Rosenow has a patent PCT/AU2016/000079 issued to the Australian Patent Office.

  • Conflict of interest: O. Breuer has nothing to disclose.

  • Conflict of interest: C. Murray has nothing to disclose.

  • Conflict of interest: H.A.W.M. Tiddens reports other from Roche and Novartis, grants from CFF, Vertex, Chiesi, Vectura and NCFS, outside the submitted work. In addition, he has a patent PRAGMA-CF scoring system issued and is head of the Erasmus MC-Sophia Children's Hospital core laboratory LungAnalysis.

  • Conflict of interest: F. Ramanauskas has nothing to disclose.

  • Conflict of interest: S.C. Ranganathan has nothing to disclose.

  • Conflict of interest: G.L. Hall has nothing to disclose.

  • Conflict of interest: S.M. Stick has nothing to disclose.

  • Support statement: Cystic Fibrosis Foundation (http://dx.doi.org/10.13039/100000897), National Health and Medical Research Council (http://dx.doi.org/10.13039/501100000925). Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received April 16, 2019.
  • Accepted February 12, 2020.
  • Copyright ©ERS 2020
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Structural determinants of long-term functional outcomes in young children with cystic fibrosis
Lidija Turkovic, Daan Caudri, Tim Rosenow, Oded Breuer, Conor Murray, Harm A.W.M. Tiddens, Fiona Ramanauskas, Sarath C. Ranganathan, Graham L. Hall, Stephen M. Stick
European Respiratory Journal May 2020, 55 (5) 1900748; DOI: 10.1183/13993003.00748-2019

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Structural determinants of long-term functional outcomes in young children with cystic fibrosis
Lidija Turkovic, Daan Caudri, Tim Rosenow, Oded Breuer, Conor Murray, Harm A.W.M. Tiddens, Fiona Ramanauskas, Sarath C. Ranganathan, Graham L. Hall, Stephen M. Stick
European Respiratory Journal May 2020, 55 (5) 1900748; DOI: 10.1183/13993003.00748-2019
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