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Bronchodilator Responsiveness in Cystic Fibrosis Children Treated for Pulmonary Exacerbations
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  • Mordechai Pollak,
  • Michelle Shaw,
  • David Wilson,
  • Melinda Solomon,
  • Felix Ratjen,
  • Hartmut Grasemann
Mordechai Pollak
The Hospital for Sick Children
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Michelle Shaw
The Hospital for Sick Children
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David Wilson
The Hospital for Sick Children
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Melinda Solomon
The Hospital for Sick Children
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Felix Ratjen
The Hospital for Sick Children
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Hartmut Grasemann
The Hospital for Sick Children
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Abstract

Background: Cystic fibrosis (CF) pulmonary exacerbations (PEx) are associated with significant drop in pulmonary function. The clinical value of measuring bronchodilator (BD) responsiveness during treatment for PEx to monitor or predict recovery of lung function is unclear. Methods: A retrospective analysis of spirometry with BD response testing obtained during hospital admissions for PEx in pediatric CF patients. Repeated events were included for patients with BD testing during multiple admissions. Results: 249 spirometries with BD testing in 102 patients were completed around day 7 (day 4-10) of hospital admission for treatment of CF PEx. Median (IQR) forced expiratory volume in one second (FEV1) was 70.6% predicted (58.1, 84.6) prior to the PEx event (best FEV1 in 6 months prior to admission), 54.4% (41.5, 66.9) at admission, 62.3% (48.4, 74.7) around day 7 of admission and 67.1% predicted (53.8, 78.2) at end of treatment. BD response around day 7 correlated poorly with FEV1 prior to PEx (r=-0.16, p=0.02), and did not correlate with recovery to baseline FEV1 at end of treatment (r=0.08, p=0.22). Only 23/249 (9%) patients had a BD response of ≥12 % and 200 ml. BD response was not related to age or severity of lung disease and led to an immediate change in clinical management in only 4 cases. CONCLUSIONS: BD response in CF patients treated for PEx is poorly correlated with baseline pulmonary function and does not correlate with recovery of FEV1 with treatment. These data suggest that routine testing for BD response is not indicated during PEx.

Peer review status:ACCEPTED

07 Jan 2021Submitted to Pediatric Pulmonology
08 Jan 2021Submission Checks Completed
08 Jan 2021Assigned to Editor
11 Jan 2021Reviewer(s) Assigned
01 Feb 2021Review(s) Completed, Editorial Evaluation Pending
02 Feb 2021Editorial Decision: Revise Major
23 Mar 20211st Revision Received
23 Mar 2021Reviewer(s) Assigned
23 Mar 2021Submission Checks Completed
23 Mar 2021Assigned to Editor
02 Apr 2021Review(s) Completed, Editorial Evaluation Pending
03 Apr 2021Editorial Decision: Accept