Relationship between Inhaled Corticosteroid Therapy and Rate of Lung Function Decline in Children with Cystic Fibrosis

doi:10.1016/j.jpeds.2008.07.010

The Journal of Pediatrics

Volume 153, Issue 6, December 2008, Pages 746-751.e2

https://doi.org/10.1016/j.jpeds.2008.07.010 Get rights and content

Objective

To assess the relationship between inhaled corticosteroids (ICS) use and lung function decline in children with cystic fibrosis (CF) using the Epidemiologic Study of Cystic Fibrosis, an observational study of patients with CF in North America.

Study design

We analyzed data from 2978 patients 6 to 17 years old enrolled in ESCF between 1994 to 2004. We estimated the rate of decline in forced expiratory volume in 1 second (FEV₁) before and after starting ICS therapy with a piecewise linear continuous single change point model, adjusting for potentially confounding covariates.

Results

Before initiation of ICS, mean FEV₁ decline was −1.52% predicted/year (95% CI: −1.96 to −1.08% predicted/year). After initiation of ICS therapy, mean FEV₁ decline was −0.44% predicted/year (95% CI: −0.85 to −0.03% predicted/year), which was a significant change (P = .002). ICS use was associated with decreased height for age Z scores and increased insulin/oral hypoglycemic use.

Conclusions

In this retrospective analysis of prospectively collected data, ICS therapy in patients with CF was associated with a significant reduction in the rate of FEV₁ decline, decreased linear growth, and increased insulin/oral hypoglycemic use.

Section snippets

Methods

Data collected by the ESCF from 1994 to 2004 were used for this analysis. The design and implementation of the ESCF have previously been described.¹⁸ In brief, the ESCF is a prospective, encounter-based, observational study of patients with CF in North America. A total of 261 study sites participated in ESCF, with a cumulative enrollment of 32 585 unique study patients. Data were collected at every patient encounter and included pulmonary function data, anthropometric data, clinical findings,

Results

From the 32 585 patients enrolled in ESCF between 1994 and 2005, 1208 met the criteria for inclusion in the analysis; 786 of these patients had ICS use recorded on 100% of the post-index encounters. A detailed description of how the study cohort was derived is shown in Figure 2 (available at www.jpeds.com). The Comp group was drawn from patients never receiving ICS during the course of ESCF, who did not have allergic bronchopulmonary aspergillosis before index and had at least 3 encounters and 3

Discussion

In this retrospective analysis of data from a large prospective observational study of patients with CF in North America, we observed a significant association between ICS use and a slower rate of FEV₁ decline in children with CF. The net difference in FEV₁ decline before and after the index visit was 1.08% predicted/year (95% CI = 0.39-1.77), a 70% reduction from the initial rate of FEV₁ decline. This observation persisted after adjusting for covariates in our model that could have accounted

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: Financial support and conflict of interest information available at www.jpeds.com (Appendix 2).

^⁎: List of members available at www.jpeds.com (Appendix 1).

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Original articleRelationship between Inhaled Corticosteroid Therapy and Rate of Lung Function Decline in Children with Cystic Fibrosis

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Clin Chest Med

J Pediatr

J Pediatr

Chest

J Pediatr

Respir Med

J Pediatr

Effect of high-dose ibuprofen in patients with cystic fibrosis

N Engl J Med

Inhaled glucocorticoids for asthma

N Engl J Med

Controlled trial of inhaled budesonide in patients with cystic fibrosis and chronic bronchopulmonary Psuedomonas aeruginosa infection

Am J Respir Crit Care Med

Beclomethasone diproprionate reduced airway inflammation without adrenal suppression in young children with cystic fibrosis: a pilot study

Pediatr Pulmonol

Randomised controlled trial of inhaled corticosteroids (fluticasone propionate) in cystic fibrosis

Arch Dis Child

Original article
Relationship between Inhaled Corticosteroid Therapy and Rate of Lung Function Decline in Children with Cystic Fibrosis