Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Home care equivalent to hospital care for some patients with cystic fibrosis

08.07.2010
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.

... more about:
»FEV1 »Hopkins »Twin-Sibling »lung function

"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."

Keely Savoie | EurekAlert!
Further information:
http://www.thoracic.org

Further reports about: FEV1 Hopkins Twin-Sibling lung function

More articles from Studies and Analyses:

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Rainbow colors reveal cell history: Uncovering β-cell heterogeneity

22.09.2017 | Life Sciences

Penn first in world to treat patient with new radiation technology

22.09.2017 | Medical Engineering

Calculating quietness

22.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>