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. 2002 Oct;87(4):306–311. doi: 10.1136/adc.87.4.306

Early airway infection, inflammation, and lung function in cystic fibrosis

G Nixon 1, D Armstrong 1, R Carzino 1, J Carlin 1, A Olinsky 1, C Robertson 1, K Grimwood 1
PMCID: PMC1763045  PMID: 12244003

Abstract

Aims: To determine the relation between lower airway infection and inflammation, respiratory symptoms, and lung function in infants and young children with cystic fibrosis (CF).

Methods: A prospective study of children with CF aged younger than 3 years, diagnosed by a newborn screening programme. All were clinically stable and had testing as outpatients. Subjects underwent bronchial lavage (BL) and lung function testing by the raised volume rapid thoracoabdominal compression technique under general anaesthesia. BL fluid was cultured and analysed for neutrophil count, interleukin 8, and neutrophil elastase. Lung function was assessed by forced expiratory volume in 0.5, 0.75, and 1 second.

Results: Thirty six children with CF were tested on 54 occasions. Lower airway infection shown by BL was associated with a 10% reduction in FEV0.5 compared with subjects without infection. No relation was identified between airway inflammation and lung function. Daily moist cough within the week before testing was reported on 20/54 occasions, but in only seven (35%) was infection detected. Independent of either infection status or airway inflammation, those with daily cough had lower lung function than those without respiratory symptoms at the time of BL (mean adjusted FEV0.5 195 ml and 236 ml respectively).

Conclusions: In young children with CF, both respiratory symptoms and airway infection have independent, additive effects on lung function, unrelated to airway inflammation. Further studies are needed to understand the mechanisms of airway obstruction in these young patients.

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Figure 1 .

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(A) Neutrophil percentages in bronchial lavage fluid, by symptom and infection group. AU, asymptomatic/uninfected (n = 22); AI, asymptomatic/infected (n = 8); SU, symptomatic/uninfected (n = 13); SI, symptomatic/infected (n = 6). Open circles represent individual values; closed circles are geometric means following adjustment for repeated measures, with 95% CI. (B) Lung function by symptom and infection group. Open circles represent individual values for each subject; closed circles represent the mean FEV0.5 adjusted by analysis of variance for height for each group, with 95% CI. AU, n = 26; AI, n = 8; SU, n = 13; SI, n = 6).

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