Factors associated with response to treatment of pulmonary exacerbations in cystic fibrosis patients

Waters, Valerie; Stanojevic, Sanja; Sonneveld, Nicole; Klingel, Michelle; Grasemann, Hartmut; Yau, Yvonne; Tullis, Elizabeth; Wilcox, Pearce; Freitag, Andreas; Chilvers, Mark; Ratjen, Félix

doi:10.1016/j.jcf.2015.01.007

Cited by 70 publications

(63 citation statements)

References 32 publications

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“…In addition, sputum NE activity predicts failure of lung function recovery after treatment of a CF pulmonary exacerbation, which is consistent with the present study in which lung function response correlated with changes in NE activity [11]. In addition, higher NE activity is associated with a shorter time to subsequent pulmonary exacerbation [11]. BAL fluid NE activity is also an independent predictor for the development of bronchiectasis in infants with CF [12].…”

Section: Discussionsupporting

confidence: 90%

“…Sputum NE activity is a predictor of future lung function decline [10]. In addition, sputum NE activity predicts failure of lung function recovery after treatment of a CF pulmonary exacerbation, which is consistent with the present study in which lung function response correlated with changes in NE activity [11]. In addition, higher NE activity is associated with a shorter time to subsequent pulmonary exacerbation [11].…”

Section: Discussionsupporting

confidence: 89%

“…These previous studies using intravenous antibiotic therapy in CF patients have shown more pronounced reductions in both bacterial load, as measured by CFUs, and markers of inflammation [11,23,24]. There are limited data comparing different routes of antibiotic therapy, but a small study in CF patients suggested that reduction of inflammation is greater with intravenous versus inhaled antibiotic therapy [25].…”

Section: Discussionmentioning

confidence: 99%

“…The evolution of airway inflammation over time, the effect of acute exacerbations as well as the link between inflammation and subsequent course of lung disease have been extensively studied in CF [8][9][10][11][12]. However, similar information is lacking for PCD patients.…”

Section: Introductionmentioning

confidence: 99%

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Changes in airway inflammation during pulmonary exacerbations in patients with cystic fibrosis and primary ciliary dyskinesia

et al. 2015

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Lung disease in patients with both primary ciliary dyskinesia (PCD) or cystic fibrosis (CF) is associated with impaired mucociliary clearance; however, clinical outcomes are typically worse in CF patients. We assessed whether CF and PCD patients differ in inflammatory response in the airways during pulmonary exacerbation.We first studied clinically stable PCD patients with a spectrum of bacterial pathogens to assess inflammatory response to different pathogens. Subsequently, PCD and CF patients with similar bacterial pathogens were studied at the time of a pulmonary exacerbation and after 21 days of antibiotics treatment. Qualitative and quantitative microbiology, cell counts, interleukin-8 concentrations, and neutrophil elastase activity were assessed in sputum samples obtained before and after treatment.In stable PCD patients, no significant differences were found in sputum inflammatory markers between individuals colonised with different bacterial pathogens. Pulmonary exacerbation severity assessed by a pulmonary exacerbation score and lung function decline from their previous baseline did not differ between CF and PCD patients. Bacterial density for Staphylococcus aureus and Haemophilus influenzae was higher in CF versus PCD ( p<0.05), but absolute neutrophil counts were higher in PCD patients ( p=0.02). While sputum elastase activity was similar in PCD and CF at the time of exacerbation, it decreased with antibiotic therapy in PCD ( p<0.05) but not CF patients.PCD patients differ from those with CF in their responses to treatment of pulmonary exacerbations, with higher neutrophil elastase activity persisting in the CF airways at the end of treatment. @ERSpublications PCD patients differ from those with CF in their responses to treatment of pulmonary exacerbations

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in airway inflammation during pulmonary exacerbations in patients with cystic fibrosis and primary ciliary dyskinesia

et al. 2015

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“…Sputum measures of airway inflammation have also been shown to decrease after treatment of a pulmonary exacerbation with IV antibiotics 73 . In a study of IV antibiotics, higher sputum NE on day 14 of therapy for a pulmonary exacerbation was associated with increased risk of subsequent exacerbation 74 .…”

Section: Host- Response In Cf Lung Diseasementioning

confidence: 96%

Cystic Fibrosis

Zemanick

Hoffman

2016

Pediatric Clinics of North America

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THE EARLIEST DESCRIPTIONS OF LUNG DISEASE IN PEOPLE WITH CYSTIC FIBROSIS (CF) DEMONSTRATED THE INVOLVEMENT OF THREE INTERACTING PATHOPHYSIOLOGICAL ELEMENTS IN CF AIRWAYS: MUCUS OBSTRUCTION, INFLAMMATION, AND INFECTION. OVER THE PAST 7 DECADES, OUR UNDERSTANDING OF CF RESPIRATORY MICROBIOLOGY AND INFLAMMATION HAS EVOLVED WITH THE INTRODUCTION OF NEW TREATMENTS, WITH INCREASED LONGEVITY, AND WITH INCREASINGLY SOPHISTICATED LABORATORY TECHNIQUES. IN THIS CHAPTER, WE WILL REVIEW THE CURRENT STATE OF UNDERSTANDING OF THE ROLES OF INFECTION AND INFLAMMATION AND THEIR ROLES IN DRIVING LUNG DISEASE. WE WILL ALSO DISCUSS HOW THIS CONSTANTLY EVOLVING INFORMATION IS USED TO INFORM CURRENT THERAPEUTIC STRATEGIES, MEASURES AND PREDICTORS OF DISEASE SEVERITY, AND RESEARCH PRIORITIES.

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Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

Waters

Ratjen

2017

Cochrane Database of Systematic Reviews

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The current evidence, limited to one study, shows that there is insufficient evidence to determine effect of choosing antibiotics based on combination antimicrobial susceptibility testing compared to choosing antibiotics based on conventional antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in people with cystic fibrosis with chronic Pseudomonas aeruginosa infection. A large international and multicentre study is needed to further investigate this issue.The only study included in the review was published in 2005, and we have not identified any further relevant studies up to March 2017. We therefore do not plan to update this review until new studies are published.

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Factors associated with response to treatment of pulmonary exacerbations in cystic fibrosis patients

Abstract: Inadequate reduction of inflammation during an exacerbation is associated with failure to recover lung function and increased risk of subsequent re-exacerbation in CF patients.

Cited by 70 publications

References 32 publications

Changes in airway inflammation during pulmonary exacerbations in patients with cystic fibrosis and primary ciliary dyskinesia

Changes in airway inflammation during pulmonary exacerbations in patients with cystic fibrosis and primary ciliary dyskinesia

Cystic Fibrosis

Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

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