| 1. |
- Blomquist, Axel, et al.
(författare)
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Persistent Aspergillus fumigatus infection in cystic fibrosis : impact on lung function and role of treatment of asymptomatic colonization-a registry-based case-control study
- 2022
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Ingår i: BMC Pulmonary Medicine. - : Springer Science and Business Media LLC. - 1471-2466. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Aspergillus fumigatus is the most common filamentous fungus isolated from the airways of people with cystic fibrosis (CF). The aim of this study was to investigate how chronic A. fumigatus colonization affects lung function in people with CF, to identify risk factors for colonization, and to evaluate antifungal treatment of asymptomatic Aspergillus colonization.METHODS: Data from 2014-2018 was collected from the Swedish CF registry and medical records. Baseline data before the start of A. fumigatus colonization was compared with the two succeeding years to evaluate how colonization and treatment affected lung function and other clinical aspects.RESULTS: A total of 437 patients were included, of which 64 (14.6%) became colonized with A. fumigatus during the study period. Inhaled antibiotics was associated with A. fumigatus colonization (adjusted OR 3.1, 95% CI 1.6-5.9, p < 0.05). Fungal colonization was not associated with a more rapid lung function decline or increased use of IV-antibiotics compared to the non-colonized group, but patients with A. fumigatus had more hospital days, a higher increase of total IgE, and higher eosinophil counts. In the Aspergillus group, 42 patients were considered to be asymptomatic. Of these, 19 patients received antifungal treatment. Over the follow up period, the treated group had a more pronounced decrease in percent predicted Forced Expiratory Volume in one second (ppFEV1) compared to untreated patients (- 8.7 vs - 1.4 percentage points, p < 0.05).CONCLUSION: Inhaled antibiotics was associated with A. fumigatus colonization, but no association was found between persistent A. fumigatus and subsequent lung function decline. No obvious benefits of treating asymptomatic A. fumigatus colonization were demonstrated.
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| 2. |
- Svedberg, Marcus, 1975, et al.
(författare)
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Chest X-rays are less sensitive than multiple breath washout examinations when it comes to detecting early cystic fibrosis lung disease
- 2022
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 111:6, s. 1253-1260
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Tidskriftsartikel (refereegranskat)abstract
- Aim Annual chest X-ray is recommended as routine surveillance to track cystic fibrosis (CF) lung disease. The aim of this study was to investigate the clinical utility of chest X-rays to track CF lung disease. Methods Children at Gothenburg's CF centre who underwent chest X-rays, multiple breath washouts and chest computed tomography examinations between 1996 and 2016 were included in the study. Chest X-rays were interpreted with Northern Score (NS). We compared NS to lung clearance index (LCI) and structural lung damage measured by computed tomography using a logistic regression model. Results A total of 75 children were included over a median period of 13 years (range: 3.0-18.0 years). The proportion of children with abnormal NS was significantly lower than the proportion of abnormal LCI up to the age of 4 years (p < 0.05). A normal NS and a normal LCI at age 6 years were associated with a median (10-90th percentile) total airway disease of 1.8% (0.4-4.7%) and bronchiectasis of 0.2% (0.0-1.5%). Conclusion Chest X-rays were less sensitive than multiple breath washout examinations to detect early CF lung disease. The combined results from both methods can be used as an indicator to perform chest computed tomography less frequently.
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| 3. |
- Svedberg, Marcus, 1975, et al.
(författare)
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Longitudinal lung clearance index and association with structural lung damage in children with cystic fibrosis
- 2023
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 78:2, s. 176-182
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Tidskriftsartikel (refereegranskat)abstract
- What is the key question? Can longitudinal multiple breath washout examination estimate the extent and the progression rate of CF lung disease measured with chest CT? What is the bottom line? A low lung clearance index during childhood is associated with a lower extent and slower progression rate of structural lung damage compared with a higher lung clearance index. Why read on? To better understand how longitudinal lung clearance index may be used in clinical practice.
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| 4. |
- Svedberg, Marcus, 1975
(författare)
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Monitoring cystic fibrosis lung disease in children - Clinical utility and associations between functional and structural methods
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cystic Fibrosis (CF) is an inherited progressive disease that causes severe damage to the airways and other organs of the body. Many methods are available to track CF lung disease but longitudinal data are needed to better understand the clinical utility and associations between different methods. The main aim of this doctoral thesis was to analyse and compare longitudinal data from lung function tests and image tests in children with CF. Methods: In study I children aged 6–17 years attending Gothenburg’s CF clinic underwent multiple breath washout examinations, spirometry tests and a clinical stability assessment every 3rd month over a period of 1 year. Variability of the outcome parameters were analysed. In study II–IV 75 children aged 0–17 years underwent multiple breath washout examinations, spirometry tests, chest computer tomography (CT) and chest x-ray examinations between 1996– 2016 at Gothenburg CF centre. Longitudinal trends and associations between outcome measures were analysed together with the effect of respiratory infections and other confounding factors. Results: A total of 25 children completed a total of 107 visits of which 104 visits had complete data available in study I. The relative change in lung clearance index and FEV1% was +-17% (95th percentile) at clinical stable visits. In study II–IV a total of 75 participants with CF were included together with a healthy cohort of 140 children aged 0–17 years. Children with CF underwent lung functions tests and image tests and the healthy cohort only underwent multiple breath washout examinations. Study II demonstrated that intermittent and chronic infections were associated with an increased progression rate of structural lung disease measured with chest CT. Study III demonstrated associations between longitudinal LCI and the extent and progression rate of structural lung damage assessed with chest CT. The Lung clearance index was more sensitive than chest x-rays to detect early CF lung disease in study IV. The combined results of a normal chest x-ray and a normal lung clearance index were associated with a low extent of lung damage assessed with chest CT. Conclusions: Multiple breath washout is a sensitive method to detect early CF lung disease. Lung function and imagine tests captured different dimensions of CF lung disease. The use of multiple methods in clinical practice provides a more robust assessment of CF lung disease than using either measure alone.
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| 5. |
- Svedberg, Marcus, 1975, et al.
(författare)
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Risk factors for progression of structural lung disease in school-age children with cystic fibrosis
- 2020
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Ingår i: Journal of Cystic Fibrosis. - : Elsevier BV. - 1873-5010 .- 1569-1993. ; 19:6, s. 910-916
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Tidskriftsartikel (refereegranskat)abstract
- Background: Computed 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. Method: Seventy-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. Results: The 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). Conclusion: Intermittent 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.
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