Intravenous (IV) antibiotics are a mainstay of therapy in children with cystic fibrosis. It is unclear, however, over what period associated improvements in pulmonary function are maintained, and to what extent the underlying inflammatory process is impeded in children admitted for a course of IV antibiotics. This was a prospective, interventional study of 14 children (median age, 14 years; interquartile range, 10-14) with cystic fibrosis who were regular sputum producers and who required admission for a 2-week course of IV antibiotics. Children performed spirometry and provided a sputum sample prior to starting IV antibiotics and then weekly for 6 weeks, the first 2 weeks of which IV antibiotics were given. Sputum IL-8, TNF-alpha, IL-6, IL-10, MIP1-alpha, and elastase were measured. Seven children were asked to repeat the protocol in a subsequent exacerbation to assess similarities in response to therapy. Significant improvements were seen in forced expired volume in 1 sec (FEV(1)) in association with IV antibiotics (27% relative improvement in predicted from baseline to end of week 1, median FEV(1) 41.3% increasing to 52.2%), but this continued only 1 week following cessation of antibiotics. Although IL-8 demonstrated a trend for reduction in association with antibiotics, no significant profile was demonstrated for any of the cytokines assessed. IL-10 was detectable in 64% of samples (all <100 pg/ml). In children with two episodes assessed, although there was a close correlation of FEV(1) and FVC between exacerbations (before antibiotics), no significant correlation was seen for IL-8, TNF-alpha, or IL-10 measured in both sets of samples at any sample point (indeed, a discordant response was seen between sample points in the two exacerbations). Although FEV(1) temporarily improves in response to admission for IV antibiotics, no such response is seen in sputum cytokine values. In addition, assessment of cytokines in subsequent exacerbations does not show a similar pattern of response to treatment.

Conclusion Thus, we have confirmed that spontaneous pneumothorax is a poor prognostic factor in CF, with 57% of patients experiencing a recurrent pneumothorax within the first year and poor one and 2-year survival rates. Surgical treatment was associated with a lower risk of recurrence, but at the expense of an increase in mortality. Randomised controlled trials of treatment options and the formulation of guidelines are required to determine the timing and optimal management to prevent recurrent pneumothorax in CF patients. Background Screening for cystic fibrosis related diabetes (CFRD) is recommended as part of the cystic fibrosis annual review. For children over 10 an oral glucose tolerance test (OGTT) is recommended, but this is time consuming and adds to the burden of assessments and investigations of the annual review. As part of a proposed wider pragmatic study to evaluate the feasibility of home OGTT testing in this patient group, we assessed the level of agreement between blood glucose concentration measured by near-patient testing using the Accucheck glucometer and that measured in the laboratory using standard methods (True Lab GlucosedTLG). P241 ACCUCHEK (TM) MEASUREMENT OF BLOOD GLUCOSE CORRELATES WITH TRUE LAB GLUCOSE MEASUREMENT IN CHILDREN SCREENED FOR CYSTIC FIBROSIS RELATED DIABETESMethods 26 children with CF aged 1 yre16 yrs undergoing annual review were studied. Blood taken at the time of venepuncture was tested for glucose concentration using an Accucheck glucometer, and results compared with TLG. For children under 10 a single, random blood glucose was tested using each method. For those aged 10 or over samples taken after an overnight fast, and 2 h after a standard OGTT oral glucose load were tested using each method. Bland and Altman statistics were used to assess limits of agreement between methods of glucose measurement. Results 31 pairs of glucose measurements were obtained. TLG measurements ranged from 4.1 to 10.6 mmol/l. Abstract P241 Figure 1 shows the Accucheck glucose measurement plotted against the TLG for each sample, and the line of equality. The agreement between Accucheck and TLG was investigated using the method of Bland and Altman and showed that the Accucheck gave results a mean (SD) of 0.26 (0.84) mmol/l higher than values obtained on TLG.Conclusions There is a clinically acceptable agreement between blood glucose measured by Accucheck compared with TLG. Just one child with a TLG result that might have prompted further investigation could have been missed, had Accucheck been the sole method used. This suggests that blood glucose measurement in the context of OGTT screening for CFRD could perhaps be performed using near-patient testing in an out of hospital setting (eg, by parents at home) without compromising test validity. Further research is needed to establish if this is the case. Background Cystic Fibrosis (CF) is the commonest inherited life threatening condition in the UK and is a multisystem disease. CF related low bone mineral density (BMD) is defined as a Z scor...