Long term follow up of changes in FEV1 and treatment intensity during Pseudomonas aeruginosa colonisation in patients with cystic fibrosis
Medical School
Hannover, Pediatric Pneumonology, 30625 Hannover, Germany
Correspondence to: Dr M Ballmann.
Received 30 July 1997; Returned to authors 29 September 1997; Revised version received 17 April 1998; Accepted for publication 6 May 1998
BACKGROUND
Colonisation
with Pseudomonas aeruginosa (PA) is a
striking feature of lung involvement in cystic fibrosis. To identify
the clinical consequences of the different steps of colonisation with PA under a defined therapeutic regime (no prophylactic antibiotic treatment as long as patients had no severe pulmonary disease), their
influence on pulmonary function and on therapeutic intensity was examined.
METHODSForty patients
with cystic fibrosis were followed from first detection of PA (PA1),
chronic PA colonisation (PAc), first mucoid PA detection (PAm), to
chronic mucoid PA colonisation (PAcm). Percentage predicted forced
expiratory volume in one second (FEV1), the number of
intravenous antibiotic treatment courses, and the percentage of
patients on inhaled antibiotics were followed retrospectively and
longitudinally in relation to the different steps of PA colonisation. The annual changes in FEV1 and therapeutic intensity in the
two years preceding each step were compared with the two years
following each step. Changes in FEV1 were related to
therapeutic intensity.
RESULTSThe mean (SD)
annual changes in FEV1 (% predicted) worsened
significantly only with the transition to the mucoid stages (PAm: 4.6 (13.2) versus -4.3 (8.1); PAcm: 7.3 (12.0) versus -4.8 (7.4)) with a
mean difference (95% CI) between before and after the transition of
8.9 (2.6 to 15.2) for PAm and 12.1 (6.4 to 17.6) for PAcm. With
non-mucoid PA stages the therapeutic intensity increased in the year of
transition and with mucoid PA stages it increased in the years
following transition. Therapeutic intensity was unrelated to changes in
FEV1.
CONCLUSIONWith the
treatment regime used an accelerated decrease in FEV1 was
successfully prevented in the non-mucoid stages but not in the mucoid
stages of PA colonisation.
© 1998 by Thorax
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