Probiotic use in adults with cystic fibrosis is common and influenced by gastrointestinal health needs: A cross‐sectional survey study

Abstract

Background: Cystic fibrosis (CF) primarily affects the lung, however, gastrointestinal disorders and symptoms, including dysbiosis, also impact on morbidity and quality of life. There is interest in strategies to modulate the gastrointestinal microbiota, including probiotics, although the evidence remains inadequate to guide practice, and information on use is limited. The present study aimed to characterise probiotic use, beliefs and experiences of adults with CF. Methods: A cross-sectional questionnaire study was conducted in adults with CF (n = 205) and a general population Control group (n = 158), recruited from Victoria, Australia. Participants were classified as probiotic 'Ever Users' or 'Never Users'. Outcomes included self-reported probiotic use and factors associated with probiotic use, which were analysed using logistic regression analysis. Open-ended questionnaire responses were thematically analysed. Results: In total, 70% of adults with CF had ever used probiotics (supplements and/or foods), comparable to Controls (80%) (p = 0.03). Key reasons for CF probiotic use were gastrointestinal-and antibiotic-related (75%). Most CF Ever Users (73%) did not discuss probiotic use with CF clinicians and 33% were uncertain if probiotics had been helpful. Female gender (odds ratio [OR] = 2.82; 95% confidence interval [CI] = 1.36-5.87; p = 0.005), universitylevel education (OR = 2.73; 95% CI = 1.24-6.01; p = 0.01) and bloating on antibiotics (OR = 2.14; 95% CI = 1.04-4.40; p = 0.04) were independently associated with probiotic use in CF; as was female gender in Controls (OR = 2.84; 95% CI = 1.20-6.71; p = 0.02). Conclusions: Probiotics were used by adults with CF for gastrointestinal-and antibiotic-related reasons often without informing clinicians and despite uncertainty about perceived helpfulness. Further research investigating gastrointestinal outcomes of probiotics will inform practice recommendations guiding their use in CF and other chronic diseases.

Evolution of nutritional management in children with cystic fibrosis – a narrative review

“…In a US survey, up to 60% of patients were using a probiotic, 129 and in a similar Australian survey 70% reported to have ever used probiotics. 130 A recent Cochrane Review on the use of probiotics found a significant reduction in faecal calprotectin (a marker of intestinal inflammation) in children and adults with CF. 131 They concluded that some 'likely' benefit exists for probiotic use, but the evidence was considered low certainty.…”

“…Another area of interest is the use of pre, pro and synbiotics in this population. In a US survey, up to 60% of patients were using a probiotic, 129 and in a similar Australian survey 70% reported to have ever used probiotics 130 . A recent Cochrane Review on the use of probiotics found a significant reduction in faecal calprotectin (a marker of intestinal inflammation) in children and adults with CF 131 .…”

Nutritional management of people living with cystic fibrosis throughout life and disease continuum: Changing times, new challenges

“…Other mechanisms involve production of antimicrobial peptides, stimulation of resident immune cells, regulation of bile acid metabolism, and synthesis of short‐ and branched‐chain fatty acids 150 . A recent survey showed that adults living with CF frequently used probiotics, but more commonly for GI and antibiotic‐related purposes 151 . Despite being unsure about their helpfulness, many participants considered probiotics safe and used them without consulting healthcare professionals, highlighting the need for clinical trials to test the efficacy of probiotics in relieving CF GI symptoms.…”

“…150 A recent survey showed that adults living with CF frequently used probiotics, but more commonly for GI and antibiotic-related purposes. 151 Despite being unsure about their helpfulness, many participants considered probiotics safe and used them without consulting healthcare professionals, highlighting the need for clinical trials to test the efficacy of probiotics in relieving CF GI symptoms. A few probiotic clinical trials have been conducted in CF populations but have primarily focused on respiratory outcomes, with limited attention given to GI outcomes.…”