Risk factors for progression of structural lung disease in school-age children with cystic fibrosis

BackgroundComputed tomography (CT) is used to monitor progression of structural lung disease (SLD) in children with cystic fibrosis (CF). Our goals were to identify the risk factors for the annual progression of SLD and the impacts of airway pathogens on SLD.MethodSeventy-five school-aged children diagnosed with CF underwent 200 CT scans at Gothenburg CF Centre in the period 2003–2015. SLD was evaluated with a quantitative scoring system. Mixed models were used to calculate the yearly progression rates of SLD and FEV₁ and to analyse the effects of common airway pathogens in CF.ResultsThe yearly mean progression (95% CI) rates for total disease (%Dis), bronchiectasis (%Be), and FEV₁ were 0.62 (0.38–0.86), 0.43 (0.28–0.58) and −0.16 (−0.18–0.13), respectively. Adjusting for airway pathogens, the yearly mean progression rates for %Dis, %Be and FEV₁ were 0.23 (−0.04–0.51), 0.12 (0.00–0.25), and −0.12 (−0.16–0.08), respectively. A single infection with P aeruginosa was associated with significant increase in lung damage, assessed as %Dis (p = 0.044) and%Be (p = 0.0047), but not in FEV₁ (p = 0.96). At age of 7 years, there was a good correlation between the extent of SLD and subsequent progression of %Dis (r = 0.63, p = 0.0042) and %Be (r = 0.74, p = 0.0057) while there was no significant correlation between the FEV₁ and the rate of decline of FEV₁ (r = −0.22, p = 0.12).ConclusionIntermittent respiratory infections with P aeruginosa were associated with significant SLD but no change in FEV₁. More SLD at the age of 7 years signals a higher progression rate of SLD subsequently.