Standardized Treatment of Pulmonary Exacerbations (STOP) study: Physician treatment practices and outcomes for individuals with cystic fibrosis with pulmonary Exacerbations

被引：72

作者：

West, Natalie E. ^{[1
]}

Beckett, Valeria V. ^{[2
]}

Jain, Raksha ^{[3
]}

Sanders, Don B. ^{[4
]}

Nick, Jerry A. ^{[5
]}

Heltshe, Sonya L. ^{[2
,6
]}

Dasenbrook, Elliott C. ^{[7
]}

VanDevanter, Donald R. ^{[8
]}

Solomon, George M. ^{[9
,10
]}

Goss, Christopher H. ^{[2
,6
,11
]}

Flume, Patrick A. ^{[12
,13
]}

机构：

[1] Johns Hopkins Univ, Dept Med, Baltimore, MD USA

[2] Seattle Childrens Res Inst, Cyst Fibrosis Fdn, Therapeut Dev Network, Coordinating Ctr, Seattle, WA USA

[3] Univ Texas Southwestern Med Ctr Dallas, Dept Med, Dallas, TX 75390 USA

[4] Indiana Univ, Dept Pediat, Indianapolis, IN 46204 USA

[5] Natl Jewish Hlth, Dept Med, Denver, CO USA

[6] Univ Washington, Dept Pediat, Seattle, WA 98195 USA

[7] Cleveland Clin, Resp Inst, Cleveland, OH 44106 USA

[8] Case Western Reserve Univ, Sch Med, Dept Pediat, Cleveland, OH 44106 USA

[9] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA

[10] Univ Alabama Birmingham, Gregory Fleming James Cyst Fibrosis Ctr, Birmingham, AL USA

[11] Univ Washington, Dept Med, Seattle, WA USA

[12] Med Univ South Carolina, Dept Med, Charleston, SC 29425 USA

[13] Med Univ South Carolina, Dept Pediat, 171 Ashley Ave, Charleston, SC 29425 USA

来源：

JOURNAL OF CYSTIC FIBROSIS | 2017年 / 16卷 / 05期

基金：

美国国家卫生研究院;

关键词：

Cystic fibrosis; Pulmonary Exacerbations; Physician treatment practices; Antibiotic therapy; ANTIBIOTIC-TREATMENT; CHILDREN; ADULTS; FEV1; PREDICTORS; MORTALITY; DURATION; LOCATION; DECLINE;

D O I：

10.1016/j.jcf.2017.04.003

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background: Pulmonary Exacerbations (PEx) are associated with increased morbidity and mortality in individuals with CF. PEx management practices vary widely, and optimization through interventional trials could potentially improve outcomes. The object of this analysis was to evaluate current physician treatment practices and patient outcomes for PEx. Methods: The Standardized Treatment of Pulmonary Exacerbations (STOP) observational study enrolled 220 participants 12 years old admitted to the hospital for PEx at 11 U.S. CF centers. Spirometry and daily symptom scores were collected during the study. Physicians were surveyed on treatment goals and their management practices were observed. Treatment outcomes were compared to stated goals. Results: The mean (SD) duration of IV antibiotic treatment was 15.9 (6.0) days. Those individuals with more severe lung disease (<50% FEV1) were treated nearly two days longer than those with >50% FEV1. Physician-reported FEV1 improvement goals were 10% (95% CI: 5%, 14%) lower for patients with 6-month baseline FEV1 <= 50% predicted compared with those with 6-month baseline FEV1 >50% predicted. There were clinically and statistically significant improvements in symptoms from the start of IV antibiotic treatment to the end of IV antibiotic treatment and 28 days after the start of treatment. The mean absolute increase in FEV1 from admission was 9% predicted at end of IV antibiotic treatment, and 7% predicted at day 28. Only 39% fully recovered lost lung function, and only 65% recovered at least 90% of lost lung function. Treatment was deemed successful by 84% of clinicians, although 6-month baseline FEV1 was only recovered in 39% of PEx. Conclusions: In this prospective observational study of PEx, treatment regimens and durations showed substantial variation. A significant proportion of patients did not reach physician's treatment goals, yet treatment was deemed successful. (C) 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

引用

页码：600 / 606

页数：7

共 25 条

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