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  1. Andrew Bush,
  2. Ian Pavord

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CF lung attacks: more than just transient trouble

The feeble word ‘exacerbation’ has been applied to deterioration in health status in CF patients usually requiring intravenous antibiotics, but with the expectation that all will be well, and the whole thing is minor nuisance value, like getting a plumber to fix a dripping tap. Not so. It is known that around a quarter of patients do not go back to baseline spirometry, and now an even more disturbing study in Thorax reports that CF patients more than two ‘exacerbations’ a year have a greater likelihood of a >5% rate of decline in FEV1 over the study period, and are more likely to die or undergo a lung transplant. Perhaps unsurprisingly, those who had multiple exacerbations were more likely to be female, diabetic and have poor baseline lung function. As with all good studies, new questions arise. Are the multiple CF lung attacks a marker of intrinsically more serious disease, or is the problem adherence to treatment? Are the multiple CF lung attacks causal of an accelerated decline in lung function, or are the attacks and the decline …

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