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Early pulmonary infection, inflammation, and clinical outcomes in infants with cystic fibrosis *
Author(s) -
Rosenfeld Margaret,
Gibson Ronald L.,
McNamara Sharon,
Emerson Julia,
Burns Jane L.,
Castile Robert,
Hiatt Peter,
McCoy Karen,
Wilson Christopher B.,
Inglis Andrew,
Smith Arnold,
Martin Thomas R.,
Ramsey Bonnie W.
Publication year - 2001
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1144
Subject(s) - cystic fibrosis , medicine , bronchoalveolar lavage , air trapping , inflammation , lung , immunology , respiratory disease , respiratory infection , pulmonary function testing , respiratory system , gastroenterology
A thorough understanding of the early natural history of cystic fibrosis (CF) lung disease is critical for the development of effective interventions in the youngest patients. We assessed the evolution of pulmonary infection, inflammation, and clinical course among 40 infants over a 2‐year period through annual bronchoalveolar lavage (BAL) for culture and measurements of pro‐ and anti‐inflammatory cytokines, semiannual infant pulmonary function testing, and quarterly clinical evaluations. Both the prevalence of CF pathogens and their density in BAL fluid increased with age. Infants had neutrophilic lower airway inflammation and elevated IL‐8 concentrations independent of whether CF pathogens were recovered. Total leukocyte and neutrophil densities and IL‐8 concentrations increased with density of CF pathogens in BAL fluid, whether the isolated organism was P. aeruginosa or another pathogen. IL‐10 concentrations were similar in CF subjects and non‐CF historical controls. Infants generally had suboptimal growth (low weight and height percentiles) and obstructive lung disease (decreased expiratory flows and air trapping). Subjects from whom CF pathogens were isolated at > 10 5 cfu/mL had the worst air trapping and lowest Brasfield chest X‐ray scores. Our findings provide a foundation for future studies of early intervention in CF lung disease, including antimicrobial and anti‐inflammatory therapy. Pediatr Pulmonol. 2001; 32:356–366. © 2001 Wiley‐Liss, Inc.