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This document details the standards of care for patients with cystic fibrosis (CF) in Australia. It outlines comprehensive inpatient and outpatient care protocols, management strategies for different age groups, and transition requirements for patients. Specific medical treatments, nutritional advice, and recommendations for lung transplantation and ongoing support for families are also discussed, emphasizing the importance of tailored healthcare strategies to address individual patient needs systematically.
Pediatric Pulmonology, 2007
Journal of Cystic Fibrosis, 2009
This is the third article related to a review of the literature based on data from national cystic fibrosis (CF) patient registries up to June 2008 and covering a total of 115 published studies. It focuses on several topics: CF incidence, genotype/phenotype correlation, microbiology, pregnancy/ paternity, clinical complications, lung transplantation, and others.
ACTA MEDICA IRANICA, 2019
Cystic fibrosis (CF), as a fatal genetic condition, is associated with high morbidity and mortality rates. In Iran, limited studies exist on this disease. This study aimed to compare the demographic, clinical and paraclinical data of CF patients. This cross-sectional study was conducted in 2014-2015 on 174 CF patients referred to the Tehran Children Medical Center hospital, which is the main referral center for CF. For each patient, the forced expiratory volume in one second (FEV1) was measured, and the comparative demographic, clinical, and laboratory data of patients were recorded. Overall, 59% of studied patients were boys (n=102) and 41% were girls (n=72). The mean patient age (and standard deviations) was 7.1±5.7 years, with a range of 10 days to 28 years. In 67% of cases, the disease was diagnosed before their first birthday. The patients in this study were classified based on the FEV1 into mild (62%), moderate (33%) and severe (5%), indicating the degree of pulmonary complications. Cultures of respiratory secretions were positive for Pseudomonas aeruginosa and Staphylococcus aureus, in 23% and 16% of cases, respectively. In total, 61% of patients (n=83) were assigned to receive oral azithromycin for prophylaxis. Gastroesophageal reflux (reflux) was the most common gastrointestinal complication (35%). Regarding the complex nature of CF and the necessity of constant monitoring of patients during the lifespan , the comparative demographic, clinical and laboratory analysis of patients and registering and standardization of patients' data can be a major step in the better understanding of the disease, and thereby increasing the quality of life and life expectancy in the affected population.
Journal of the American Academy of Nurse Practitioners, 2012
Revista Portuguesa de Pneumologia (English Edition), 2017
Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. Although most cases are diagnosed in childhood, diagnosis in adults is apparently increasing. Objective: Evaluate the adult population with CF, comparing patients who were diagnosed before and after 18 years of age. Methods: Retrospective analysis of patients followed in three main medical centres in Portugal in 2012. Comparison of two groups: G1-patients diagnosed at <18 years and G2-patients diagnosed at ≥18 years. Results: 89 adults were identified: 61.8% in G1, 38.2% in G2. Gender distribution was similar in both groups. Average age in G2 was higher (38.3 ± 8.4 vs. 26.8 ± 6.1 years, p < 0.001). Respiratory symptoms most frequently led to CF diagnosis in all patients, mainly in adulthood. There was a greater percentage of patients homozygous for the mutation delF508 in G1 (43.6 vs. 8.8%, p = 0.02). Respiratory and pancreatic function, and body mass index (BMI) showed a higher severity in G1 (G1 vs. G2: FEV1: 54.6 ± 27.3 vs. 29.9 ± 64.6%, p = 0.177; pancreatic insufficiency 72.7 vs. 26.5%, p < 0.001; BMI 20.2 ± 3.4 vs. 22.2 ± 4.8, p = 0.018). Pseudomonas aeruginosa and methicillin-sensitive Staphylococcus aureus were the most frequently isolated microorganisms. Lung transplantation rate was higher in G2 (20.6 vs. 10.9%, p = 0.231) while mortality rate was higher in G1 (0 vs. 3.6%, p = 0.261). Hospital admission rate was higher in G1 as well as mortality rate. Conclusion: The results suggest that patients with CF diagnosed in childhood have characteristics that distinguish them from those diagnosed in adulthood, and these differences may have implications for diagnosis, prognosis and life expectancy.
Journal of Cystic Fibrosis, 2010
This is the third article related to a review of the literature based on data from national cystic fibrosis (CF) patient registries up to June 2008 and covering a total of 115 published studies. It focuses on several topics: CF incidence, genotype/phenotype correlation, microbiology, pregnancy/ paternity, clinical complications, lung transplantation, and others.
2010
This is the third article related to a review of the literature based on data from national cystic fibrosis (CF) patient registries up to June 2008 and covering a total of 115 published studies. It focuses on several topics: CF incidence, genotype/phenotype correlation, microbiology, pregnancy/ paternity, clinical complications, lung transplantation, and others.
Oman Medical Journal, 2015
ystic Fibrosis (CF) is an autosomal recessive disease and occurs in the Caucasian population with a prevalence of 1:2500 1 making it one of the most common genetic disorders in this population. CF affects mucus-producing organs and presents predominantly with respiratory and gastrointestinal symptoms. The disease is clinically characterized by chronic airways infection and inflammation, resulting in lung fibrosis and progressive loss of pulmonary function. Lung disease is believed to be the leading cause of 90% of deaths in patients with CF. 3 A failure to thrive is a result of pancreatic insufficiency and subsequent malabsorption of nutrients, resulting in reduced weight gain and difficulties in maintaining body weight. Medical care concepts have advanced in Europe and Northern America, where specialized CF centers provide holistic CF care. The advanced care concepts, developed over the last four decades, have contributed to an increase in life expectancy from only six months in 1959 to around 30 years by 2003. Where optimum CF care is available the predicted median survival is now more than 50 years. 9-11 Some of these advances in CF care are yet to be realized in Oman. The current average life expectancy for people with CF in the North Al Batinah region was recently reported as only 10.5 years. 12 In addition, there is limited research available on the perceived impact of CF on daily life from the patients perspective, nor is there research on the cultural/ethnic and socioeconomic factors that influence attitudes to health and disease with respect to CF care in Oman. A central part of CF care is the prevention, diagnosis, and treatment of acute pulmonary exacerbations (PEx). They are clinically characterized original article
Medicine & Science in Sports & Exercise, 2014
Introduction: Lung function, nutritional status and parameters of exercise capacity are known predictors of mortality in patients with Cystic Fibrosis (CF). The aim of the current study was to utilize these important parameters to develop a multivariate model to predict mortality in adolescent patients with CF. Methods: A total of 127 adolescents with CF (57 girls) with a mean age of 12.7 ± 0.9 years and a mean percentage of predicted forced expired volume in 1 sec (FEV 1 % predicted ) of 77.7 ±15.6% was included. CPET-derived parameters, nutritional status and resting lung functions were dichotomized according to the criterion value determined using ROC curves. Body mass index (BMI), FEV 1 % predicted , predicted peak oxygen uptake corrected for body weight (VO 2peak/kg % predicted ), peak minute ventilation (VE peak ), peak VE/VO 2 , peak VE/VCO 2 , and breathing reserve were included in a multivariate model. The Cox proportional hazards model was used to determine the combination of parameters that best predicted mortality and/or lung transplantation. Results: Mean duration of follow-up was 7.5 ±2.7 years, during which 9 of the 127 patients died (7.1%) and 6 (4.7 %) underwent lung transplantation. Mortality in this population was best predicted by the model that included FEV 1 %pred (HR = 17.13, 95%CI = 3.76-78.06), peak VE/VO 2 (HR =5.92, 95%CI = 1.27-27.63) and BMI (HR = 5.54, 95%CI = 1.82-16.83). Conclusions: The currently developed model consisting of BMI, FEV 1 %pred and VE/VO 2 is a strong predictor of mortality rate in adolescents with CF. This prediction equation may be useful in clinical practice to detect patients earlier with a high risk of mortality and to provide them with additional therapy.
The Journal of Pediatrics, 2008
No reprints are available from the authors. Changes in CF Descriptive Terminology Attempts to classify individuals with CF based on sweat chloride values are not as useful as was envisioned originally. 80 CF lung disease, the main cause of morbidity and mortality, has been identified in every group. Furthermore, patients diagnosed with CF as newborns who then receive the recommended specialized care may have a delay in pulmonary involvement for decades. Thus, such classification schemes as "atypical" or "typical," "mild" or "severe," and "classical" or "nonclassical" are not recommended. The authors recognize that some of these terms are embedded in the literature and that NBS programs will continue to use "classical" and "atypical," but as time passes the clinical distinctions will not be sharp enough to sustain such terminology. Although once considered an unambiguous disease entity resulting in death in early childhood, CF is now known to cause a wide spectrum of disease, and determining an individual's prognosis is not possible using currently available tools. In fact, individuals who initially display few deleterious health effects can develop severe disease in 1 or more organ systems. Therefore, careful monitoring and timely treatment are crucial for all affected individuals.
Pediatric Pulmonology, 2008
We hypothesized that in CF infants microbiologic surveillance with targeted antibiotic intervention preserves pulmonary function. Our program follows a standardized protocol with microbiologic surveillance performed at every visit by oropharyngeal sampling for culture. Positive cultures are treated based on antibiotic susceptibility regardless of clinical status. First detection of Pseudomonas aeruginosa (PA) is treated with a 6 week course of ciprofloxacin and 6 months of inhaled Colistin. Pulmonary function (PFT) is assessed by raised-volume rapid thoracoabdominal compression (RVRTC) and multi-breath washout (MBW). Nutritional status is monitored by weight for length Z-score (WLZ). Twenty four CF infants have participated since 2008. Mean age at diagnosis was 6.8 weeks, 16 are female. On average, 75% of the cultures per patient were positive. Only 6 of the infants had at least one positive culture for PA. In contrast 75% of the infants had at least one positive culture for S. aureus. By RVRTC parameters only 4 infants had evidence for significant obstruction. However by MBW almost all had evidence for mild ventilatory inhomogeneity (mean LCI 8.5±1.1). No correlation was found between RVRTC and MBW parameters. We did find an inverse correlation between WLZ and LCI (r=0.46). Further, we found no relationship between microbiologic results and PFT parameters. Patients with positive cultures, including those with PA, had comparable PFT results to those not infected. Thus, despite airway colonization with CF pathogens, there was no evidence for significant detrimental changes in lung function. We propose that frequent monitoring and targeted use of antibiotics preserves lung function in infants with CF.
Journal of Cystic Fibrosis, 2012
This is the third article related to a review of the literature based on data from national cystic fibrosis (CF) patient registries up to June 2008 and covering a total of 115 published studies. It focuses on several topics: CF incidence, genotype/phenotype correlation, microbiology, pregnancy/ paternity, clinical complications, lung transplantation, and others.
International Journal of Environmental Research and Public Health, 2018
Data collected in the European Cystic Fibrosis Society Patient Registry (ECFSPR) database were used to investigate whether risk factors for death in childhood and adolescents CF patients have different impact in countries of different income. In this way, it is possible to recognize where interventions could improve the quality of care and survival in these patients. We matched deceased and alive patients by age, country, year of follow-up. Multivariable logistic models were developed. In the years of this study, the ECFSPR collected information on 24,416 patients younger than 18 years: 7830 patients were from countries with low/middle income and 16,586 from countries with high income; among these the dead are 102 and 107 (p < 0.001), respectively. The use of oxygen, forced expiratory volume in one second (FEV1) below 40% and BMI standard deviation score (SDS) below −2 represent risk factors for death. However, some patients from countries with high income remain alive even if th...
Journal of Cystic Fibrosis, 2010
Journal of Cystic Fibrosis, 2011
Objectives: CF multidisciplinary care has been associated with dramatic improvements in lung function and nutritional status. In view of the less established service for primary ciliary dyskinesia (PCD), we compared lung function and growth of children with CF with PCD matches to assess comparative clinical outcomes. Sample: 37 PCD patients were identified through diagnostic cilial brushing results. CF patients were matched by age and sex. The set was 59% male and mean age was 10.08 years (range 0.87 to 17.08). Methods: Height and weight measurements were used to calculate BMI and z scores. The best lung function and any positive microbiology on sputum samples from the preceding 12 months were compared. Results: Percent predicted FVC was significantly better in patients with CF compared with those with PCD (98.0 vs 80.7, p = 0.001). There was no significant difference in percent predicted FEV 1 (82 vs 78; p = 0.42). Z scores for weight were −0.55 and −0.37 (p = 0.51), height −0.59 and −0.59 (p = 0.99) and BMI −0.15 and −0.23 (p = 0.76) respectively. In 19% of the CF group, all cultures were negative over the study period, compared with 28% with PCD (p = 0.41). 39% with CF had at least 1 sputum positive for haemophilus influenzae compared with 58% with PCD (p = 0.11). For Pseudomonas, the results were 33% and 14% respectively (p = 0.05). Conclusion: Despite normal absorption there was evidence of suboptimal nutrition in children with PCD, comparable to that of children with CF. This, together with significantly better lung function in CF, supports the inclusion of dietitians and physiotherapists in MDTs caring for patients with PCD and a centralized coordinated approach to their care.
Journal of Cystic Fibrosis, 2005
Journal of Cystic Fibrosis Official Journal of the European Cystic Fibrosis Society, 2014
Specialised CF care has led to a dramatic improvement in survival in CF: in the last four decades, well above what was seen in the general population over the same period. With the implementation of newborn screening in many European countries, centres are increasingly caring for a cohort of patients who have minimal lung disease at diagnosis and therefore have the potential to enjoy an excellent quality of life and an even greater life expectancy than was seen previously. To allow high quality care to be delivered throughout Europe, a landmark document was published in 2005 that sets standards of care. Our current document builds on this work, setting standards for best practice in key aspects of CF care. The objective of our document is to give a broad overview of the standards expected for screening, diagnosis, pre-emptive treatment of lung disease, nutrition, complications, transplant/end of life care and psychological support. For comprehensive details of clinical care of CF, references to the most up to date European Consensus Statements, Guidelines or Position Papers are provided in Table 1. We hope that this best practice document will be useful to clinical teams both in countries where CF care is developing and those with established CF centres.
Respiratory Care, 2009
The 43rd RESPIRATORY CARE Journal Conference brought together experts from the United States, Canada, and the United Kingdom to review the art and science of cystic fibrosis (CF). This is the first time that CF was the topic for the Journal Conference, and it came about 6 decades after the disease was named, and 20 years after the gene was discovered on chromosome 7. Though CF is a multisystem disease, it is the chronic and progressive lung disease that causes most of the morbidity and mortality. The participants at the conference reviewed the epidemiology, pathophysiology, treatment, and novel therapies in the pipeline for CF lung disease. They also emphasized the many crucial roles that the respiratory therapist plays in CF, including diagnostic testing, aerosol therapies, airway clearance, infection control, patient and peer education, and patient advocacy. The May and June 2009 issues of the Journal reflect how diligently the participants worked to provide up-to-date reviews and lively discussions of these topics.
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