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Poor recovery from cystic fibrosis pulmonary exacerbations is associated with poor long‐term outcomes
Author(s) -
Sanders Don B.,
Zhao Qianqian,
Li Zhanhai,
Farrell Philip M.
Publication year - 2017
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.23765
Subject(s) - medicine , cystic fibrosis , exacerbation , inclusion and exclusion criteria , confidence interval , pediatrics , pathology , alternative medicine
Rationale People with CF treated with IV antibiotics for a pulmonary exacerbation (PEx) frequently fail to recover to baseline FEV 1 . The long‐term impact of these events has not been studied. Objectives To determine if a patient's spirometric recovery after a PEx is associated with time to next PEx within 1 year, the spirometric recovery after the next PEx, and/or the number of PEx episodes in the next 3 years. Methods We used data from the CF Foundation Patient Registry from 2004 to 2011. We randomly selected one PEx per patient that met inclusion/exclusion criteria. Patients were defined as Non‐Responders if their best FEV 1 (in liters) recorded in the 3 months after the PEx was <90% of the best FEV 1 (in liters) in the 6 months before the PEx. We compared Responders and Non‐Responders using multivariable regression models. Results We randomly chose 13 954 PEx episodes that met inclusion/exclusion criteria. A total of 2 762 (19.8%) patients were classified as Non‐Responders. Non‐Responders had a shorter median time to the next PEx, 235 (95%CI 218, 252) days, versus >365 days for Responders. Thirty‐four percent of Non‐Responders at the initial PEx were also Non‐Reponders at the next PEx, versus 20% of Responders at the initial PEx. Non‐Responders had more PEx episodes over the next 3 years, 4.99 (95%CI 4.84, 5.13), than Responders, 3.46 (95%CI 3.41, 3.51). Conclusions Poor recovery after a PEx is associated with a shorter time to the next PEx, increased risk of poor recovery at a second PEx, and more frequent subsequent PEx treatments.