Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Pediatr Pulmonol. 2022 Jul;57(7):1709-1716. doi: 10.1002/ppul.25925. Epub 2022 May 3.
Forced expiratory volume in 1 s (FEV1) decline (ΔFEV1) is associated with pulmonary exacerbation (PEx) diagnosis in cystic fibrosis (CF). Spirometry may not be available during telehealth visits and could impair clinician ability to diagnose PEx. This study aims to (1) identify the associations between degrees of ΔFEV1 (decrease of <5% predicted vs. 5%-9% predicted vs. ≥10% predicted from baseline), clinical symptoms, and clinician-diagnosed PEx and (2) evaluate the correlation between respiratory symptoms, ΔFEV1, and antibiotic treatment.
Retrospective, descriptive study of PEx diagnosis and management in 628 outpatient clinical encounters with spirometry in 178 patients with CF ages 6-17 years at Riley Hospital for Children during 2019. Odds ratios (OR) of symptoms associated with clinician-defined PEx diagnosis and antibiotic management stratified by ΔFEV1 decline were determined.
Clinician-diagnosed PEx occurred at 199 (31.7%) visits; increased cough (77.4%) and sputum/wet cough (57.8%) were the most frequently reported symptoms. Compared to no ΔFEV1, the odds of a clinician-diagnosed PEx were increased when ΔFEV1 and ΔFEV1 was present with increased cough (OR 1.56, 95% confidence interval [CI] 1.25-1.94 and OR 1.82, 95% CI 1.52-2.19, respectively), increased sputum (OR 1.59, 95% CI 1.20-2.12 and OR 1.78, 95% CI 1.37-2.32, respectively), and increased cough and sputum together (OR 1.51, 95% CI 1.08-2.13 and OR 1.68, 95% CI 1.22-2.31, respectively).
ΔFEV1 is associated with increased likelihood that cough and sputum are diagnosed as a PEx. Spirometry is essential for PEx diagnosis and treatment and is a necessary component of all clinical encounters.
1 秒用力呼气容积（FEV1）下降（ΔFEV1）与囊性纤维化（CF）中的肺部恶化（PEx）诊断相关。在远程医疗就诊期间，可能无法进行肺活量测定，并且可能会损害临床医生诊断 PEx 的能力。本研究旨在：（1）确定ΔFEV1（从基线下降<5%预测值、5%-9%预测值、≥10%预测值）的程度与临床症状和临床医生诊断的 PEx 之间的关联，（2）评估呼吸症状、ΔFEV1 和抗生素治疗之间的相关性。
对 2019 年在 Riley 儿童医院接受 178 例 CF 患者 6-17 岁的 628 次门诊临床就诊的 PEx 诊断和管理进行回顾性描述性研究，这些就诊时均进行了肺活量测定。根据 ΔFEV1 下降程度，确定与临床医生定义的 PEx 诊断和抗生素管理相关的症状的比值比（OR）。
临床医生诊断的 PEx 发生在 199 次就诊（31.7%）中；咳嗽增加（77.4%）和咳痰/湿咳（57.8%）是最常报告的症状。与无 ΔFEV1 相比，当 ΔFEV1 和 ΔFEV1 与咳嗽增加（OR 1.56，95%置信区间 [CI] 1.25-1.94 和 OR 1.82，95% CI 1.52-2.19）、痰增加（OR 1.59，95% CI 1.20-2.12 和 OR 1.78，95% CI 1.37-2.32）或咳嗽和痰都增加（OR 1.51，95% CI 1.08-2.13 和 OR 1.68，95% CI 1.22-2.31）时，发生临床医生诊断的 PEx 的可能性更大。
ΔFEV1 与咳嗽和咳痰被诊断为 PEx 的可能性增加有关。肺活量测定对 PEx 的诊断和治疗至关重要，是所有临床就诊的必要组成部分。
