. Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.
. Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil.
J Bras Pneumol. 2022 Jun 6;48(3):e20210237. doi: 10.36416/1806-3756/e20210237. eCollection 2022.
Pulmonary disease in cystic fibrosis (CF) is characterised by recurrent episodes of pulmonary exacerbations (PExs), with acute and long-term declines in lung function (FEV1). The study sought to determine whether routine spirometry increases the frequency of PEx diagnosis, resulting in benefits to long-term pulmonary function.
CF patients in the 5- to 18-year age bracket were followed for 1 year, during which they underwent spirometry before every medical visit. The main variables were the frequency of PEx diagnosis and use of antibiotics; the use of spirometry as a criterion for PEx diagnosis (a decline ≥ 10% in baseline FEV1); and median percent predicted FEV1 over time. The data were compared with those for the previous 24-month period, when spirometry was performed electively every 6 months.
The study included 80 CF patients. PExs were diagnosed in 27.5% of the visits, with a mean frequency of 1.44 PExs per patient/year in 2014 vs. 0.88 PExs per patient/year in 2012 (p = 0.0001) and 1.15 PExs per patient/year in 2013 (p = 0.05). FEV1 was used as a diagnostic feature in 83.5% of PExs. In 21.9% of PExs, the decision to initiate antibiotics was solely based on an acute decline in FEV1. The median percent predicted FEV1 during the follow-up year was 85.7%, being 78.5% in 2013 and 76.8% in 2012 (p > 0.05). The median percent predicted FEV1 remained above 80% during the two years after the study.
Routine spirometry is associated with higher rates of diagnosis and treatment of PExs, possibly impacting long-term pulmonary function.
囊性纤维化（CF）患者的肺部疾病表现为反复发生的肺部恶化（PEx），导致肺功能（FEV1）急性和长期下降。本研究旨在确定常规肺活量测定是否会增加 PEx 诊断的频率，从而带来长期肺功能的益处。
5 至 18 岁的 CF 患者随访 1 年，每次就诊前均进行肺活量测定。主要变量是 PEx 诊断和使用抗生素的频率；将肺活量测定作为 PEx 诊断的标准（FEV1 基线下降≥10%）；以及随时间推移的中位预测 FEV1 百分比。将数据与前 24 个月（每 6 个月选择性进行肺活量测定）进行比较。
本研究共纳入 80 名 CF 患者。27.5%的就诊时诊断为 PEx，2014 年每位患者/年的平均 PEx 发生率为 1.44 次，而 2012 年为 0.88 次/患者/年（p = 0.0001），2013 年为 1.15 次/患者/年（p = 0.05）。FEV1 用于 83.5%的 PEx 诊断。在 21.9%的 PEx 中，开始使用抗生素的决定仅基于 FEV1 的急性下降。随访年内的中位预测 FEV1 为 85.7%，2013 年为 78.5%，2012 年为 76.8%（p > 0.05）。研究后两年内，中位预测 FEV1 保持在 80%以上。
常规肺活量测定与 PEx 的诊断和治疗率较高相关，可能对长期肺功能产生影响。
