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Background  Functional deterioration in cystic fibrosis (CF) may be reflected by increasing bronchial obstruction and, as recently shown, by ventilation inhomogeneities. This study investigated which physiological factors (airway obstruction, ventilation inhomogeneities, pulmonary hyperinflation, development of trapped gas) best express the decline in lung function, and what role specific  CFTR  genotypes and different types of bronchial infection may have upon this process.    Methods  Serial annual lung function tests, performed in 152 children (77 males; 75 females) with CF (age range: 6–18 y) provided data pertaining to functional residual capacity (FRC pleth , FRC MBNW ), volume of trapped gas (V TG ), effective specific airway resistance (sR eff ), lung clearance index (LCI), and forced expiratory indices (FVC, FEV 1 , FEF 50 ).    Results  All lung function parameters showed progression with age. Pulmonary hyperinflation (FRC pleth  > 2SDS) was already present in 39% of patients at age 6–8 yrs, increasing to 67% at age 18 yrs. The proportion of patients with V TG  > 2SDS increased from 15% to 54% during this period. Children with severe pulmonary hyperinflation and trapped gas at age 6–8 yrs showed the most pronounced disease progression over time. Age related tracking of lung function parameters commences early in life, and is significantly influenced by specific  CFTR  genotypes. The group with chronic  P. aeruginosa  infection demonstrated most rapid progression in all lung function parameters, whilst those with chronic  S. aureus  infection had the slowest rate of progression. LCI, measured as an index of ventilation inhomogeneities was the most sensitive discriminator between the 3 types of infection examined ( p  < 0.0001).    Conclusion  The relationships between lung function indices,  CFTR  genotypes and infective organisms observed in this study suggest that measurement of other lung function parameters, in addition to spirometry alone, may provide important information about disease progression in CF.

Progression of pulmonary hyperinflation and trapped gas associated with genetic and environmental factors in children with cystic fibrosis