CYSTIC FIBROSIS

Predictors of pulmonary exacerbations in patients with cystic fibrosis infected with multi-resistant bacteria

J K Block¹, K L Vandemheen¹, E Tullis³, D Fergusson¹, S Doucette¹, D Haase⁴, Y Berthiaume⁵, N Brown⁶, P Wilcox⁷, P Bye², S Bell⁸, M Noseworthy⁹, L Pedder¹⁰, A Freitag¹⁰, N Paterson¹¹, S D Aaron¹

¹ Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada
² Woolcock Institute, Sydney, NSW, Australia
³ St Michael’s Hospital, Toronto, ON, Canada
⁴ Dalhousie University, Halifax, NS, Canada
⁵ Universite de Montreal, Montreal, QC, Canada
⁶ University of Alberta, Edmonton, AB, Canada
⁷ University of British Columbia, Vancouver, BC, Canada
⁸ The Prince Charles Hospital, Brisbane, Qld, Australia
⁹ Memorial University, St John’s, NF, Canada
¹⁰ McMaster University, Hamilton, ON, Canada
¹¹ University of Western Ontario, London, ON, Canada

Correspondence to:
Dr S D Aaron
Ottawa Hospital, General Campus, 501 Smyth Road, Mailbox 211, Ottawa, Ontario, Canada K1H 8L6; saaron{at}ottawahospital.on.ca

Background: This study examined characteristics of adult and adolescent patients with cystic fibrosis (CF) to determine factors associated with an increased risk of pulmonary exacerbations.

Methods: 249 patients with CF infected with multidrug resistant bacteria were recruited and prospectively followed for up to 4.5 years until they experienced a pulmonary exacerbation severe enough to require intravenous antibiotics. Multivariable regression analyses were used to compare the characteristics of patients who experienced an exacerbation with those who did not.

Results: 124 of the 249 patients (50%) developed a pulmonary exacerbation during the first year and 154 (62%) experienced an exacerbation during the 4.5 year study period. Factors predictive of exacerbations in a multivariable survival model were younger age (OR 0.98, 95% CI 0.96 to 0.99), female sex (OR 1.45, 95% CI 1.07 to 1.95), lower forced expiratory volume in 1 second (FEV₁) (OR 0.98, 95% CI 0.97 to 0.99), and a previous history of multiple pulmonary exacerbations (OR 3.16, 95% CI 1.93 to 5.17). Chronic use of inhaled corticosteroids was associated with an increased risk of exacerbation (OR 1.92, 95% CI 1.00 to 3.71) during the first study year.

Conclusions: Patients who experience pulmonary exacerbations are more likely to be younger, female, using inhaled steroids, have a lower FEV₁, and a history of multiple previous exacerbations. It is hoped that knowledge of these risk factors will allow better identification and closer monitoring of patients who are at high risk of exacerbations.

Abbreviations: BMI, body mass index; CF, cystic fibrosis; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity

Keywords: cystic fibrosis; pulmonary exacerbations; bacterial resistance; lung infections; risk factors

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