Navigation Links
Cystic Fibrosis foundation lays out new treatment guidelines
Date:11/15/2007

New clinical standards on the treatment of patients with cystic fibrosis (CF) have been released following an exhaustive review of all available literature.

The guidelines, a result of a two-year review of original research and systematic review literature from 1983 to 2006, were published in the second issue for November of the American Thoracic Societys American Journal of Respiratory and Critical Care Medicine.

CF is a complex genetic disease affecting the lungs and other organs, and is characterized by an unusually thick, sticky mucus that renders CF victims virtually incapable of fending off infections and pathogens. CF is always fatal, but thanks to advances in treatment in the last 60 years, life expectancy has increased from just a few years to 36 years. Lung disease accounts for 85 percent of the mortality among CF patients.

"Physicians treating patients with CF are faced with a growing number of treatment options" wrote lead author of the guidelines, Patrick A. Flume, M.D. "We are hopeful that clinicians will find these recommendations to be useful in their care of patients with CF."

The pulmonary guidelines committee assessed the clinical efficacy and safety of the use of aerosolized antibiotics, recombinant human DNase (dornase alfa), hypertonic saline inhalation, anti-inflammatory agents, macrolide antibiotics, the use of bronchodilators and N-acetylcysteine. They analyzed the clinical results with regard to the number of studies, strength of the study designs and the quality and consistency of results to make their final recommendations. Because of the general dearth of studies on treatments in children under the age of six, the committee restricted their recommendations to CF patients six years of age and older.

The treatments with the strongest, most consistent results yielding an "A"-grade positive recommendation were:

  • Inhaled tobramycin, an antibiotic, to suppress chronic Pseudomonas aeruginosa infections in CF patients with moderate to severe disease to improve lung function and reduce exacerbations; and
  • Dornase alfa, which degrades the free DNA that accumulates in CF mucus, thereby loosening the mucus, promoting airway clearance, improving lung function and reducing exacerbations.

"B" grade recommendations by the committee are for:

  • Inhaled tobramycin, to suppress chronic Pseudomonas aeruginosa infections in CF patients with mild disease or who are asymptomatic, to reduce exacerbations;
  • Dornase alfa, for CF patients with mild disease or who are asymptomatic, to improve lung function and reduce exacerbations;
  • Hypertonic saline, which hydrates surface liquid in patients with CF, thereby improving lung function and decreasing exacerbations; and
  • ]2-adrenergic receptor agonists, which relax smooth muscles and dilate bronchial passages, which improve lung-function in CF patients, and were well-tolerated.

The guidelines recommend against:

  • Systemic corticosteroids in children because of "an excess number of adverse events," including abnormalities in glucose metabolism, cataracts, and percentage of patients "colonized" with Pseudomonas (this recommendation excludes patients who have concomitant asthma);
  • Inhaled corticosteroids, because there was no clinical benefit (this recommendation excludes patients who have concomitant asthma); and
  • Prophylactic anti-Staphylococcal antibiotics because of the lack of clinical efficacy and an apparent increase in P. aeruginosa infections with their use.

All other treatments lacked sufficient evidence to recommend for or against their use.

The article includes recommendations for physicians to help determine which therapies to use, and the order in which they should be introduced. "There is a challenge for the clinician to decide what therapy to start first, or when to add another therapy," explained Dr. Flume. "We are putting together an educational program to assist the community in implementation of the guidelines and hope to launch a web-based program in January."

Still, much work remains to be done. "We were able to support our recommendations based on the quality of the evidence," said Dr. Flume. "But also we could see clearly where we were lacking data. This will allow us to lay the foundation for how those studies should be performed."

The committee plans to update the guidelines every five years.


'/>"/>

Contact: Suzy Martin
smartin@thoracic.org
212-315-8631
American Thoracic Society
Source:Eurekalert

Related medicine news :

1. Ibuprofen can slow lung disease in children with cystic fibrosis, Canadian study shows
2. Anaheim to Host Worlds Largest Cystic Fibrosis Medical Meeting
3. AMRI and Cystic Fibrosis Foundation Launch Major Research Collaboration
4. Cystic Fibrosis Foundation Named Charitable Organization of the Year by USA Track & Field
5. Coalition for Pulmonary Fibrosis Launches Aggressive Ad Campaign Directed at United States Congress
6. Liver fibrosis will be treated by a potential target
7. Resolution Recognizing Pulmonary Fibrosis Challenges Overwhelmingly Passes House
8. MRI predicts liver fibrosis, study says
9. Coalition for Pulmonary Fibrosis Fundraising Events Raise $280,000 for IPF
10. National Patient Safety Foundation Partners with Vocera Communications
11. R. P. Simmons Family Foundation Pledges $2 Million for New Childrens Hospital of Pittsburgh of UPMC Campus
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/29/2016)... ... April 29, 2016 , ... ... Celiac Association (CCA), is pleased to announce the launch of the GFCP ... articles, recipes, and more. The purpose of the GFCP Scoop site ...
(Date:4/29/2016)... ... April 29, 2016 , ... New York City based oral and maxillofacial surgeon Dr. ... very effective way to treat obstructive sleep apnea. Dr. Jamali is proud to offer this ... procedure that involves one or both jaw bones. This surgery is performed to correct the ...
(Date:4/29/2016)... ... April 29, 2016 , ... Jvion, the ... of funding led by Eastside Partners, with participation from existing investor Martin Ventures. ... base and accelerate its technology and product roadmap. , “Jvion is ...
(Date:4/29/2016)... ... April 29, 2016 , ... CURE ... entirely on patients with cancer, today announced that Lynne Malestic, RN, of Eisenhower ... 2016 CURE® Extraordinary Healer® for Oncology Nursing , which honors nurses who have ...
(Date:4/29/2016)... , ... April 29, 2016 , ... ... to promote their animal line of probiotics, Petbiotics ™, as they fondly ... turnout of animal rescue groups networking for their non-profit organizations. Animal rescues across ...
Breaking Medicine News(10 mins):
(Date:4/28/2016)... 28, 2016  While Abbott,s announced purchase of ... valve repair and stent business, healthcare research firm ... more firmly into patient monitoring.  Kalorama said that ... device areas, with double-digit growth expected the next ... Advanced Remote Patient Monitoring . Abbott Laboratories ...
(Date:4/28/2016)... 28, 2016 ... Phillips und Stephen Schmidt ... ArisGlobal®, ein führender Anbieter cloudbasierter Softwarelösungen ... bekannt, dass neue Führungskräfte zum Team Sicherheit ... die vielfältige Erfahrungen mitbringen.  Dies wird die ...
(Date:4/28/2016)... April 28, 2016 , Net Sales of ... basis over the prior year period, and an increase of ... , Diluted EPS for the first quarter were $0.52 reported, ... $2.00 adjusted, an increase of 29.9% over the prior year ... adjusted earnings guidance for 2016 Zimmer Biomet Holdings, ...
Breaking Medicine Technology: