• Kathryn A Ramsey, Sarath Ranganathan, Judy Park, Billy Skoric, Anne-Marie Adams, Shannon J Simpson, Roy M Robins-Browne, Peter J Franklin, Nick H de Klerk, Peter D Sly, Steve M Stick, Graham L Hall, and AREST CF.
• 1 Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia.
• Am. J. Respir. Crit. Care Med.. 2014 Nov 15;190(10):1111-6.

RationalePulmonary inflammation, infection, and structural lung disease occur early in life in children with cystic fibrosis.ObjectivesWe hypothesized that the presence of these markers of cystic fibrosis lung disease in the first 2 years of life would be associated with reduced lung function in childhood.MethodsLung function (forced expiratory volume in the first three-quarters of a second [FEV0.75], FVC) was assessed in individuals with cystic fibrosis diagnosed after newborn screening and healthy subjects during infancy (0-2 yr) and again at early school age (4-8 yr). Individuals with cystic fibrosis underwent annual bronchoalveolar lavage fluid examination, and chest computed tomography. We examined which clinical outcomes (pulmonary inflammation, infection, structural lung disease, respiratory hospitalizations, antibiotic prophylaxis) measured in the first 2 years of life were associated with reduced lung function in infants and young children with cystic fibrosis, using a mixed effects model.Measurements And Main ResultsChildren with cystic fibrosis (n = 56) had 8.3% (95% confidence interval [CI], -15.9 to -6.6; P = 0.04) lower FEV0.75 compared with healthy subjects (n = 18). Detection of proinflammatory bacterial pathogens (Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, Aspergillus species, Streptococcus pneumoniae) in bronchoalveolar lavage fluid was associated with clinically significant reductions in FEV0.75 (ranging between 11.3 and 15.6%).ConclusionsThe onset of lung disease in infancy, specifically the occurrence of lower respiratory tract infection, is associated with low lung function in young children with cystic fibrosis. Deficits in lung function measured in infancy persist into childhood, emphasizing the need for targeted therapeutic interventions in infancy to maximize functional outcomes later in life.

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