Semin Respir Crit Care Med 2019; 40(06): 804-809
DOI: 10.1055/s-0039-1697639
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulmonary Complications of Cystic Fibrosis

Bryan Garcia
1   Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
,
Patrick A. Flume
1   Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
2   Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Publikationsverlauf

Publikationsdatum:
28. Oktober 2019 (online)

Abstract

Cystic fibrosis (CF) lung disease is characterized by the development of progressive bronchiectasis and impaired lung function with severe airflow obstruction. CF patients suffer from shortened life expectancy, primarily driven by respiratory failure. The mechanism by which CF lung disease develops is the result of an interplay of multiple intrinsic and extrinsic factors including genotype, abnormalities in mucus composition and movement, chronic inflammation, and chronic airway infection. Although all CF patients are at increased risk for pulmonary complications including hemoptysis, pneumothorax, pulmonary hypertension, and chronic hypoxic and hypercapnic respiratory failure, the risk of developing these complications increases with progression of lung disease. The focus of this article is to summarize the pathophysiology, epidemiology, and management of these key pulmonary complications.

 
  • References

  • 1 Rowe SM, Miller S, Sorscher EJ. Cystic fibrosis. N Engl J Med 2005; 352 (19) 1992-2001
  • 2 Elkins MR, Robinson M, Rose BR. , et al; National Hypertonic Saline in Cystic Fibrosis (NHSCF) Study Group. A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. N Engl J Med 2006; 354 (03) 229-240
  • 3 Wainwright CE, Elborn JS, Ramsey BW. , et al; TRAFFIC Study Group; TRANSPORT Study Group. Lumacaftor-ivacaftor in patients with cystic fibrosis homozygous for Phe508del CFTR. N Engl J Med 2015; 373 (03) 220-231
  • 4 Ramsey BW, Pepe MS, Quan JM. , et al; Cystic Fibrosis Inhaled Tobramycin Study Group. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. N Engl J Med 1999; 340 (01) 23-30
  • 5 Ramsey BW, Davies J, McElvaney NG. , et al; VX08-770-102 Study Group. A CFTR potentiator in patients with cystic fibrosis and the G551D mutation. N Engl J Med 2011; 365 (18) 1663-1672
  • 6 George PM, Banya W, Pareek N. , et al. Improved survival at low lung function in cystic fibrosis: cohort study from 1990 to 2007. BMJ 2011; 342: d1008
  • 7 Flume PA, Mogayzel Jr PJ, Robinson KA, Rosenblatt RL, Quittell L, Marshall BC. ; Clinical Practice Guidelines for Pulmonary Therapies Committee; Cystic Fibrosis Foundation Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: pulmonary complications: hemoptysis and pneumothorax. Am J Respir Crit Care Med 2010; 182 (03) 298-306
  • 8 Hayes Jr D, Tobias JD, Mansour HM. , et al. Pulmonary hypertension in cystic fibrosis with advanced lung disease. Am J Respir Crit Care Med 2014; 190 (08) 898-905
  • 9 Elphick HE, Mallory G. Oxygen therapy for cystic fibrosis. Cochrane Database Syst Rev 2013; (07) CD003884
  • 10 Flume PA. Pneumothorax in cystic fibrosis. Curr Opin Pulm Med 2011; 17 (04) 220-225
  • 11 Ramos KJ, Smith PJ, McKone EF. , et al; CF Lung Transplant Referral Guidelines Committee. Lung transplant referral for individuals with cystic fibrosis: Cystic Fibrosis Foundation consensus guidelines. J Cyst Fibros 2019; 18 (03) 321-333
  • 12 Lord RW, Jones AM, Webb AK, Barry PJ. Pneumothorax in cystic fibrosis: beyond the guidelines. Paediatr Respir Rev 2016; 20 (Suppl): 30-33
  • 13 Tomashefski Jr JF, Bruce M, Stern RC, Dearborn DG, Dahms B. Pulmonary air cysts in cystic fibrosis: relation of pathologic features to radiologic findings and history of pneumothorax. Hum Pathol 1985; 16 (03) 253-261
  • 14 Flume PA. Pneumothorax in cystic fibrosis. Chest 2003; 123 (01) 217-221
  • 15 Amin R, Noone PG, Ratjen F. Chemical pleurodesis versus surgical intervention for persistent and recurrent pneumothoraces in cystic fibrosis. Cochrane Database Syst Rev 2012; 12: CD007481
  • 16 Flume PA, Strange C, Ye X, Ebeling M, Hulsey T, Clark LL. Pneumothorax in cystic fibrosis. Chest 2005; 128 (02) 720-728
  • 17 Fuchs HJ, Borowitz DS, Christiansen DH. , et al; The Pulmozyme Study Group. Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. N Engl J Med 1994; 331 (10) 637-642
  • 18 Thompson V, Mayer-Hamblett N, Kloster M, Bilton D, Flume PA. Risk of hemoptysis in cystic fibrosis clinical trials: a retrospective cohort study. J Cyst Fibros 2015; 14 (05) 632-638
  • 19 Stenbit A, Flume PA. Pulmonary complications in adult patients with cystic fibrosis. Am J Med Sci 2008; 335 (01) 55-59
  • 20 Flume PA. Pulmonary complications of cystic fibrosis. Respir Care 2009; 54 (05) 618-627
  • 21 Flume PA, Yankaskas JR, Ebeling M, Hulsey T, Clark LL. Massive hemoptysis in cystic fibrosis. Chest 2005; 128 (02) 729-738
  • 22 Vidal V, Therasse E, Berthiaume Y. , et al. Bronchial artery embolization in adults with cystic fibrosis: impact on the clinical course and survival. J Vasc Interv Radiol 2006; 17 (06) 953-958
  • 23 Barben J, Robertson D, Olinsky A, Ditchfield M. Bronchial artery embolization for hemoptysis in young patients with cystic fibrosis. Radiology 2002; 224 (01) 124-130
  • 24 Noone PG. Non-invasive ventilation for the treatment of hypercapnic respiratory failure in cystic fibrosis. Thorax 2008; 63 (01) 5-7
  • 25 Shakkottai A, O'Brien LM, Nasr SZ, Chervin RD. Sleep disturbances and their impact in pediatric cystic fibrosis. Sleep Med Rev 2018; 42: 100-110
  • 26 Vandeleur M, Walter LM, Armstrong DS, Robinson P, Nixon GM, Horne RSC. What keeps children with cystic fibrosis awake at night?. J Cyst Fibros 2017; 16 (06) 719-726
  • 27 Young AC, Wilson JW, Kotsimbos TC, Naughton MT. Randomised placebo controlled trial of non-invasive ventilation for hypercapnia in cystic fibrosis. Thorax 2008; 63 (01) 72-77
  • 28 Archangelidi O, Carr SB, Simmonds NJ, Bilton D, Banya W, Cullinan P, EpiNet CF. Non-invasive ventilation and clinical outcomes in cystic fibrosis: findings from the UK CF registry. J Cyst Fibros 2019; 18: 665-670
  • 29 Tonelli AR. Pulmonary hypertension survival effects and treatment options in cystic fibrosis. Curr Opin Pulm Med 2013; 19 (06) 652-661
  • 30 Poore S, Berry B, Eidson D, McKie KT, Harris RA. Evidence of vascular endothelial dysfunction in young patients with cystic fibrosis. Chest 2013; 143 (04) 939-945
  • 31 Arcasoy SM, Christie JD, Ferrari VA. , et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 2003; 167 (05) 735-740
  • 32 Montgomery GS, Sagel SD, Taylor AL, Abman SH. Effects of sildenafil on pulmonary hypertension and exercise tolerance in severe cystic fibrosis-related lung disease. Pediatr Pulmonol 2006; 41 (04) 383-385
  • 33 Tissières P, Nicod L, Barazzone-Argiroffo C, Rimensberger PC, Beghetti M. Aerosolized iloprost as a bridge to lung transplantation in a patient with cystic fibrosis and pulmonary hypertension. Ann Thorac Surg 2004; 78 (03) e48-e50
  • 34 Sood N, Paradowski LJ, Yankaskas JR. Outcomes of intensive care unit care in adults with cystic fibrosis. Am J Respir Crit Care Med 2001; 163 (02) 335-338
  • 35 Oud L. Critical illness among adults with cystic fibrosis in Texas, 2004-2013: patterns of ICU utilization, characteristics, and outcomes. PLoS One 2017; 12 (10) e0186770
  • 36 King CS, Brown AW, Aryal S, Ahmad K, Donaldson S. Critical care of the adult patient with cystic fibrosis. Chest 2019; 155 (01) 202-214
  • 37 Bartz RR, Love RB, Leverson GE, Will LR, Welter DL, Meyer KC. Pre-transplant mechanical ventilation and outcome in patients with cystic fibrosis. J Heart Lung Transplant 2003; 22 (04) 433-438
  • 38 Hayes Jr D, Kukreja J, Tobias JD, Ballard HO, Hoopes CW. Ambulatory venovenous extracorporeal respiratory support as a bridge for cystic fibrosis patients to emergent lung transplantation. J Cyst Fibros 2012; 11 (01) 40-45