Navigation Links
Home care equivalent to hospital care for some patients with cystic fibrosis
Date:7/8/2010

Patients with cystic fibrosis (CF) recover from exacerbations equally well if they are treated at home or in a hospital, according to researchers from Johns Hopkins University. Furthermore, longer treatment with antibiotics does not appear to offer any additional benefit over shorter courses.

The study was published online ahead of the print edition of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

"We undertook this research owing to the lack of clinical information of best practices in treating CF exacerbations available to physicians," said J. Michael Collaco, M.D., assistant professor at Johns Hopkins.

In 2008 patients with CF had an average lifespan of only 37.4 years, and most died of the progressive pulmonary obstruction associated with the disease. The progression of the disease may be hastened by recurrent exacerbations.

"Traditional management includes aggressive airway clearance and antibiotics, the latter frequently administered intravenously, but despite effective symptomatic therapy, many patients may never completely recover their baseline lung function. Thus, it is crucial to determine the most effective means of therapy delivery for CF respiratory exacerbations," said Dr. Collaco. "Unfortunately, due to the difficulty of performing randomized controlled trials, existing evidence is insufficient for many treatment issues, including the best site for delivery of care and the optimal duration of therapy."

Outpatient intravenous antibiotic therapy has gained widespread acceptance because of its advantages over hospitalization including: fewer absences from school or work, less disruption of family life, decreased costs per treatment course, and high patient satisfaction. However, long-term costs may not be reduced in the outpatient setting if it precipitates the need for longer and more frequent courses of antibiotics, and quality of life may not always be better.

Dr. Collaco and colleagues from Johns Hopkins University used data from 1535 individuals in 755 families from the U.S. Cystic Fibrosis Twin-Sibling Study, a large, multi-center study directed by Garry Cutting, M.D., professor of genetics at Johns Hopkins. This analysis of the Twin-Sibling Study data compared levels of baseline lung function (forced expiratory volume in one second, or FEV1) to lung function at the end of treatment and over the year after treatment.

Dr. Collaco and colleagues found that exacerbations were followed by long-term declines in lung function regardless of whether antibiotics were administered in the hospital or at home, and no difference in intervals between courses of antibiotics was observed between hospital and home.

"This research indicates that intravenous antibiotic therapy for CF respiratory exacerbations administered in the hospital and in the home may be equivalent in terms of long-term FEV1 change and interval between courses of antibiotics," said Dr. Collaco. "Furthermore, we found that, based on improvement of FEV1, optimal duration of therapy may be seven to 10 days, as opposed to between 10 and 21 days, as is seen in current practice."

Patients who had a greater decline in lung function prior to starting therapy experienced steeper long-term declines following that course of therapy, indicating that more severe exacerbations have long-lasting effects, regardless of short-term treatment success. "This finding implies that patients with drastic drops in lung function with an exacerbation should be monitored more closely following treatment, for even with recovery of lung function, they remain at higher risk for greater long-term decline," said Dr. Collaco.

Dr. Collaco acknowledged that subjects participating in the Twin-Sibling Study may be more motivated than the general CF population, and thus may have increased compliance with antibiotics and chest physiotherapy when treated at home. These subjects are also members of families where more than one sibling has CF, thus these families may be more adept with home care, which could have biased the outcome toward the benefit of home therapy.

"Ultimately," he said, "given the decline in baseline FEV1 after an exacerbation, preventing exacerbations may be more important than the approach taken to treat the exacerbation. Taken together, our findings underscore the CF community's need for determining an optimal approach to the treatment of pulmonary exacerbations. Large prospective studies are needed to answer these essential questions for CF respiratory management."


'/>"/>

Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

Related medicine news :

1. The private sale of drugs in public hospitals
2. Minnesota Department of Health Report: Nearly 6,000 Hospitalizations for COPD in 2007
3. Bariatricfurnishings.com Launches Unique Eco-friendly Seating for Health Care, Hospitality, Assisted Living Centers, and Home Use at Competitive Prices
4. Scott & White Memorial Hospital uses device to revolutionize treatment of traumatic aortic injury
5. Most pandemic plans in Ontario hospitals have not been tested: Queens University study
6. American Heart Association Comment on Hospitalization of President Bill Clinton
7. Allegheny General Hospital Study Demonstrates Safety and Potential Efficacy of Oral Allergy Treatment
8. SHARECOR Partners With Quantros, Inc. to Facilitate Core Measures and Regulatory Reporting in Louisiana Hospitals
9. Kaiser Foundation Health Plan and Hospitals Report Fourth Quarter and Fiscal Year 2009 Financial Results
10. Father Channels His Grief into Advocacy, Promotes Simple Actions to Make Hospitals Safer for Children
11. Catholic Health East and BayCare Health System Pledge $200,000 to Rebuild Hospital in Port-Au-Prince
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... ... The American Board of Family Medicine's (ABFM) Board of Directors has selected Warren ... James C. Puffer upon his retirement. Dr. Newton will serve in the position of ... end of 2018. Upon assuming the role of President and CEO on January 1, ...
(Date:10/13/2017)... (PRWEB) , ... October 13, ... ... School of Pharmacy (SOP) alumni Hannah Randall, PharmD ‘17, and Jennifer Huggins, ... professionals on guideline updates for the primary prevention of cardiovascular diseases during ...
(Date:10/13/2017)... (PRWEB) , ... October 13, 2017 , ... Many families ... However, many long-term care insurance companies have a waiver for care if the client ... elimination period, when the family pays for care, is often waived, so the benefits ...
(Date:10/13/2017)... ... October 13, 2017 , ... Global Healthcare Management’s 4th Annual Kids Fun ... NJ. This free event, sponsored by Global Healthcare Management’s CEO, Jon Letko, is ... is geared towards children of all ages; it is a non-competitive, non-timed event, which ...
(Date:10/13/2017)... ... 13, 2017 , ... Coveros, a leader in agile coaching ... contract by the Center for Medicare and Medicaid Services (CMS). The Enterprise Agile ... of Agile methodologies in a consistent and high value manner across CMS programs. ...
Breaking Medicine News(10 mins):
(Date:10/10/2017)... --  West Pharmaceutical Services, Inc. (NYSE: WST), a ... today shared the results of a study highlighting the ... administration of polio vaccines. The study results were presented ... by Dr. Ondrej Mach , Clinical Trials and ... and recently published in the journal Vaccine. i ...
(Date:10/4/2017)... , Oct. 4, 2017  According to the Centers for Disease ... end of October . PhysicianOne Urgent Care is helping communities across ... Westchester, NY , by offering no-cost* flu shots through the end ... mandated by certain health insurance regulations. ... The best time to get a flu shot is by the end ...
(Date:10/2/2017)... Oct. 2, 2017  AllianceRx Walgreens Prime, the combined ... Walgreens and pharmacy benefit manager Prime Therapeutics LLC (Prime), ... which included the unveiling of new signage at its ... well as at a few other company-owned facilities across ... to patients, some of whom will begin to see ...
Breaking Medicine Technology: