Predicting Return of Lung Function After a Pulmonary Exacerbation Using the Cystic Fibrosis Respiratory Symptom Diary-chronic Respiratory Infection Symptom Scale

Overview

Journal BMC Pulm Med

Publisher Biomed Central

Specialty Pulmonary Medicine

Date 2024 Jul 25

PMID 39049032

Authors

Eliana R Gill

Christopher H Goss

Scott D Sagel

Michelle L Wright

Sharon D Horner

Julie A Zuniga

Affiliations

Soon will be listed here.

Abstract

Background: Pulmonary exacerbations (PExs) in people with cystic fibrosis (PwCF) are associated with increased healthcare costs, decreased quality of life and the risk for permanent decline in lung function. Symptom burden, the continuous physiological and emotional symptoms on an individual related to their disease, may be a useful tool for monitoring PwCF during a PEx, and identifying individuals at high risk for permanent decline in lung function. The purpose of this study was to investigate if the degree of symptom burden severity, measured by the Cystic Fibrosis Respiratory Symptom Diary (CFRSD)- Chronic Respiratory Infection Symptom Scale (CRISS), at the onset of a PEx can predict failure to return to baseline lung function by the end of treatment.

Methods: A secondary analysis of a longitudinal, observational study (N = 56) was conducted. Data was collected at four time points: year-prior-to-enrollment annual appointment, termed "baseline", day 1 of PEx diagnosis, termed "Visit 1", day 10-21 of PEx diagnosis, termed "Visit 2" and two-weeks post-hospitalization, termed "Visit 3". A linear regression model was performed to analyze the research question.

Results: A regression model predicted that recovery of lung function decreased by 0.2 points for every increase in CRISS points, indicating that participants with a CRISS score greater than 48.3 were at 14% greater risk of not recovering to baseline lung function by Visit 2, than people with lower scores.

Conclusion: Monitoring CRISS scores in PwCF is an efficient, reliable, non-invasive way to determine a person's status at the beginning of a PEx. The results presented in this paper support the usefulness of studying symptoms in the context of PEx in PwCF.

References

Schmid-Mohler G, Yorke J, Spirig R, Benden C, Caress A . Adult patients' experiences of symptom management during pulmonary exacerbations in cystic fibrosis: A thematic synthesis of qualitative research. Chronic Illn. 2018; 15(4):245-263. DOI: 10.1177/1742395318772647. View

Sanders D, Bittner R, Rosenfeld M, Hoffman L, Redding G, Goss C . Failure to recover to baseline pulmonary function after cystic fibrosis pulmonary exacerbation. Am J Respir Crit Care Med. 2010; 182(5):627-32. PMC: 5450763. DOI: 10.1164/rccm.200909-1421OC. View

Roberts J, Dai D, Hollander Z, Ng R, Tebbutt S, Wilcox P . Multiple reaction monitoring mass spectrometry to identify novel plasma protein biomarkers of treatment response in cystic fibrosis pulmonary exacerbations. J Cyst Fibros. 2017; 17(3):333-340. DOI: 10.1016/j.jcf.2017.10.013. View

De Boer K, Vandemheen K, Tullis E, Doucette S, Fergusson D, Freitag A . Exacerbation frequency and clinical outcomes in adult patients with cystic fibrosis. Thorax. 2011; 66(8):680-5. DOI: 10.1136/thx.2011.161117. View

Szczesniak R, Li D, Su W, Brokamp C, Pestian J, Seid M . Phenotypes of Rapid Cystic Fibrosis Lung Disease Progression during Adolescence and Young Adulthood. Am J Respir Crit Care Med. 2017; 196(4):471-478. PMC: 5564675. DOI: 10.1164/rccm.201612-2574OC. View

Goss C . Acute Pulmonary Exacerbations in Cystic Fibrosis. Semin Respir Crit Care Med. 2019; 40(6):792-803. PMC: 7528649. DOI: 10.1055/s-0039-1697975. View

Zhang J, El-Majzoub S, Li M, Ahmed T, Wu J, Lipman M . Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study. Ren Fail. 2020; 42(1):294-301. PMC: 7144228. DOI: 10.1080/0886022X.2020.1744449. View

Park S, Larson J . Symptom cluster, healthcare use and mortality in patients with severe chronic obstructive pulmonary disease. J Clin Nurs. 2014; 23(17-18):2658-71. PMC: 4108559. DOI: 10.1111/jocn.12526. View

VanDevanter D, Heltshe S, Skalland M, West N, Sanders D, Goss C . C-reactive protein (CRP) as a biomarker of pulmonary exacerbation presentation and treatment response. J Cyst Fibros. 2021; 21(4):588-593. PMC: 9206040. DOI: 10.1016/j.jcf.2021.12.003. View

10.

Liou T, Adler F, FitzSimmons S, Cahill B, Hibbs J, Marshall B . Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol. 2001; 153(4):345-52. PMC: 2198936. DOI: 10.1093/aje/153.4.345. View

11.

Hankinson J, Odencrantz J, Fedan K . Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999; 159(1):179-87. DOI: 10.1164/ajrccm.159.1.9712108. View

12.

Waters V, Stanojevic S, Atenafu E, Lu A, Yau Y, Tullis E . Effect of pulmonary exacerbations on long-term lung function decline in cystic fibrosis. Eur Respir J. 2011; 40(1):61-6. DOI: 10.1183/09031936.00159111. View

13.

Britto M, Kotagal U, Hornung R, Atherton H, Tsevat J, Wilmott R . Impact of recent pulmonary exacerbations on quality of life in patients with cystic fibrosis. Chest. 2002; 121(1):64-72. DOI: 10.1378/chest.121.1.64. View

14.

Rosenfeld M, Emerson J, Pepe M, Smith A, Montgomery A, Ramsey B . Defining a pulmonary exacerbation in cystic fibrosis. J Pediatr. 2001; 139(3):359-65. DOI: 10.1067/mpd.2001.117288. View

15.

Deng L, Kent D, ORiordan D, Pantilat S, Lai J, Bischoff K . Symptom Burden Is Associated with Increased Emergency Department Utilization among Patients with Cirrhosis. J Palliat Med. 2021; 25(2):213-218. PMC: 8861938. DOI: 10.1089/jpm.2021.0219. View

16.

Beghin L, Michaud L, Loeuille G, Wizla-Derambure N, Sayah H, Sardet A . Changes in lung function in young cystic fibrosis patients between two courses of intravenous antibiotics against Pseudomonas aeruginosa. Pediatr Pulmonol. 2009; 44(5):464-71. DOI: 10.1002/ppul.21017. View

17.

Gold L, Patrick D, Hansen R, Goss C, Kessler L . Correspondence between lung function and symptom measures from the Cystic Fibrosis Respiratory Symptom Diary-Chronic Respiratory Infection Symptom Score (CFRSD-CRISS). J Cyst Fibros. 2019; 18(6):886-893. PMC: 6868291. DOI: 10.1016/j.jcf.2019.05.009. View

18.

Gold L, Hansen R, Patrick D, Tabah A, Heltshe S, Flume P . Health care costs in a randomized trial of antimicrobial duration among cystic fibrosis patients with pulmonary exacerbations. J Cyst Fibros. 2022; 21(4):594-599. PMC: 9329190. DOI: 10.1016/j.jcf.2022.03.001. View

19.

Sagel S, Thompson V, Chmiel J, Montgomery G, Nasr S, Perkett E . Effect of treatment of cystic fibrosis pulmonary exacerbations on systemic inflammation. Ann Am Thorac Soc. 2015; 12(5):708-17. PMC: 4418340. DOI: 10.1513/AnnalsATS.201410-493OC. View

20.

Bell S, Mall M, Gutierrez H, Macek M, Madge S, Davies J . The future of cystic fibrosis care: a global perspective. Lancet Respir Med. 2019; 8(1):65-124. PMC: 8862661. DOI: 10.1016/S2213-2600(19)30337-6. View