Effect of bronchoalveolar lavage-directed therapy on pseudomonas aeruginosa infection and structural lung injury in children with cystic fibrosis

Wainwright, Claire E., Vidmar, Suzanna, Armstrong, David S., Brynes, Catherine A., Carlin, John B., Cheney, Joyce, Cooper, Peter J., Grimwood, Keith, Moodie, Marj, Robertson, Colin F. and Tiddens, Harm A. 2011, Effect of bronchoalveolar lavage-directed therapy on pseudomonas aeruginosa infection and structural lung injury in children with cystic fibrosis, Journal of the American medical association, vol. 306, no. 2, pp. 163-171, doi: 10.1001/jama.2011.954.

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Title Effect of bronchoalveolar lavage-directed therapy on pseudomonas aeruginosa infection and structural lung injury in children with cystic fibrosis
Author(s) Wainwright, Claire E.
Vidmar, Suzanna
Armstrong, David S.
Brynes, Catherine A.
Carlin, John B.
Cheney, Joyce
Cooper, Peter J.
Grimwood, Keith
Moodie, MarjORCID iD for Moodie, Marj orcid.org/0000-0001-6890-5250
Robertson, Colin F.
Tiddens, Harm A.
Journal name Journal of the American medical association
Volume number 306
Issue number 2
Start page 163
End page 171
Total pages 9
Publisher American Medical Association
Place of publication Chicago, Ill.
Publication date 2011-07-13
ISSN 0098-7484
Keyword(s) bronchoalveolar lavage
children's health
cystic fibrosis
lung injury
pseudomonas aeruginosa
randomized trials
Summary Context Early pulmonary infection in children with cystic fibrosis leads to increased morbidity and mortality. Despite wide use of oropharyngeal cultures to identify pulmonary infection, concerns remain over their diagnostic accuracy. While bronchoalveolar lavage (BAL) is an alternative diagnostic tool, evidence for its clinical benefit is lacking.

Objective To determine if BAL-directed therapy for pulmonary exacerbations during the first 5 years of life provides better outcomes than current standard practice relying on clinical features and oropharyngeal cultures.

Design, Setting, and Participants The Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) randomized controlled trial, recruiting infants diagnosed with cystic fibrosis through newborn screening programs in 8 Australasian cystic fibrosis centers. Recruitment occurred between June 1, 1999, and April 30, 2005, with the study ending on December 31, 2009.

Interventions BAL-directed (n=84) or standard (n=86) therapy until age 5 years. The BAL-directed therapy group underwent BAL before age 6 months when well, when hospitalized for pulmonary exacerbations, if Pseudomonas aeruginosa was detected in oropharyngeal specimens, and after P aeruginosa eradication therapy. Treatment was prescribed according to BAL or oropharyngeal culture results.

Main Outcome Measures Primary outcomes at age 5 years were prevalence of P aeruginosa on BAL cultures and total cystic fibrosis computed tomography (CF-CT) score (as a percentage of the maximum score) on high-resolution chest CT scan.

Results Of 267 infants diagnosed with cystic fibrosis following newborn screening, 170 were enrolled and randomized, and 157 completed the study. At age 5 years, 8 of 79 children (10%) in the BAL-directed therapy group and 9 of 76 (12%) in the standard therapy group had P aeruginosa in final BAL cultures (risk difference, −1.7% [95% confidence interval, −11.6% to 8.1%]; P=.73). Mean total CF-CT scores for the BAL-directed therapy and standard therapy groups were 3.0% and 2.8%, respectively (mean difference, 0.19% [95% confidence interval, −0.94% to 1.33%]; P=.74).

Conclusion Among infants diagnosed with cystic fibrosis, BAL-directed therapy did not result in a lower prevalence of P aeruginosa infection or lower total CF-CT score when compared with standard therapy at age 5 years.

Trial Registration anzctr.org.au Identifier: ACTRN12605000665639
Language eng
DOI 10.1001/jama.2011.954
Field of Research 110203 Respiratory Diseases
Socio Economic Objective 920115 Respiratory System and Diseases (incl. Asthma)
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2011, American Medical Association
Persistent URL http://hdl.handle.net/10536/DRO/DU:30042715

Document type: Journal Article
Collections: Faculty of Health
Population Health
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