Inhaled corticosteroids and lower lung function decline in young children with cystic fibrosis

Abstract

, on behalf of the members of the Belgian CF Registry ABSTRACT: A recent American registry analysis in cystic fibrosis (CF) children showed less lung function decline after starting inhaled corticosteroid (ICS) use. We therefore examined the influence of ICS treatment on lung function in Belgian CF patients.Data from patients o6 yrs of age were eligible, provided entries on lung function, height and ICS use were available in two consecutive years. Data after oral steroid use or transplant were excluded.852 subjects contributed data with 2,976 data pairs analysed, 44.9% concerning years of ICS use. Yearly % predicted decline in forced expiratory volume in 1 s (FEV1) was 1.07% lower during ICS use (p50.001). Subgroup analysis for age revealed that the lower FEV1 decline rate during ICS use was only statistically significant in children 6-12 yrs of age (2.56%; p50.0003). Baseline FEV1 was lower by 5.89% (p,0.0001) in ICS users for all age groups combined, but there was no difference in baseline lung function in the children 6-12 yrs of age.In 6-12-yr-old children with CF, baseline lung function was similar in ICS users and nonusers, but annualised FEV1 decline was 2.56% pred lower in ICS users. Our data therefore support recent American findings.

Improved lung function using a therapeutic educational multidisciplinary program in a pediatric cystic fibrosis clinic

“…FEV1% was about 10% better in the intervention group 2 years before start of the study, moreover, all pulmonary testing parameters were getting worst in the intervention group before inclusion. The finding of a more important decrease in the intervention group who had better FEV1% (≥90%) in the two-years period prior to the study is coherent with the recent findings by de Boeck et al who described a significant higher annual rate of decline of 1.9% predicted in a group of individuals with an FEV1% ≥90% predicted compared with 0.4% predicted in a group with FEV1% < 90% predicted [14]. In this regard of a faster decline of FEV1% predicted in the intervention group prior to the intervention, with an improvement during the study period, most likely due to the intervention (TPE), becomes even more important.…”

“…Identifier le mode d'action des enzymes pancréatiques" with a true/false questionnaire) [14] and a CD ("Un voyage à travers l'appareil digestif " [7]). In regards of quality of life, no trend was seen in the CFQ r .…”

Randomised controlled trials in cystic fibrosis: what, when and how?

“…This follows an earlier report with similar findings based on North American CF registry data [13]. The data from Belgium show that while there is a beneficial effect overall, the benefit from inhaled corticosteroids was restricted to children between the ages of 6 and 12 yrs; however, no data were available from children under the age of 6 yrs [12]. The registry data demonstrated that the mean decline in FEV1 % pred in children aged 6-12 yrs was 1.37%.…”

“…in national CF data registries. In the current edition of the European Respiratory Journal, DE BOECK et al [12] report data from the Belgian national CF data registry that show a small but significant decrease in lung function decline, expressed as forced expiratory volume in 1 s (FEV1) % predicted, in children taking regular inhaled corticosteroids. This follows an earlier report with similar findings based on North American CF registry data [13].…”

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

“…Several medications have been associated to slowing down the rate of FEV 1 decline: dornase alpha (Konstan et al, 2011), ibuprofen (Konstan et al, 1995;, azithromycin (Hansen et al, 2005) and inhaled corticosteroids (De Boeck et al, 2011). This does not mean that all patients will benefit from them.…”