PT - JOURNAL ARTICLE AU - Tim Rosenow AU - L. Clara Mok AU - Lidija Turkovic AU - Luke J. Berry AU - Peter D. Sly AU - Sarath Ranganathan AU - Harm A.W.M. Tiddens AU - Stephen M. Stick TI - The cumulative effect of inflammation and infection on structural lung disease in early cystic fibrosis AID - 10.1183/13993003.01771-2018 DP - 2019 Jul 01 TA - European Respiratory Journal PG - 1801771 VI - 54 IP - 1 4099 - http://erj.ersjournals.com/content/54/1/1801771.short 4100 - http://erj.ersjournals.com/content/54/1/1801771.full SO - Eur Respir J2019 Jul 01; 54 AB - Introduction Pulmonary inflammation and infection are important clinical and prognostic markers of lung disease in cystic fibrosis (CF). However, whether in young children they are transient findings or have cumulative, long-term impacts on respiratory health is largely unknown. We aimed to determine whether their repeated detection has a deleterious effect on structural lung disease.Methods All patients aged <6 years with annual computed tomography (CT) and bronchoalveolar lavage (BAL) were included. Structural lung disease on CT (%Disease) was determined using the PRAGMA-CF (Perth–Rotterdam Annotated Grid Morphometric Analysis for CF) method. The number of times free neutrophil elastase (NE) and infection were detected in BAL were counted, to determine cumulative BAL history. Linear mixed model analysis, accounting for repeat visits and adjusted for age, was used to determine associations.Results 265 children (683 scans) were included for analysis, with BAL history comprising 1161 visits. %Disease was significantly associated with the number of prior NE (0.31, 95% CI 0.09–0.54; p=0.007) but not infection (0.23, 95% CI −0.01–0.47; p=0.060) detections. Reference equations were determined.Conclusions Pulmonary inflammation in surveillance BAL has a cumulative effect on structural lung disease extent, more so than infection. This provides a strong rationale for therapies aimed at reducing inflammation in young children.Pulmonary inflammation and infection have cumulative effects on structural lung disease in young children with CF. These observations underscore the importance of developing anti-inflammatory interventions for use in early life. http://bit.ly/2VRo8qv