News in brief: Childhood bronchitis leads to poor respiratory outcomes in middle-age; CFTR therapy protects against severe COVID; Palliative care discussion best in later stages of ILD

Wednesday, 22 Jun 2022

Childhood bronchitis leads to poor respiratory outcomes in middle-age

Children who have multiple episodes of protracted bronchitis should be followed up in later life with monitoring for potential asthma, pneumonia and bronchiectasis, Melbourne University researchers say.

The latest findings from the Tasmanian Longitudinal Health Study, which followed 8,583 people who were born in 1961, showed that having  ‘recurrent-protracted bronchitis’, before the age of seven was linked to multiple respiratory outcomes almost five decades later, including asthma, pneumonia and raised lung gas transfer.

Lead author of a paper published in BMJ Open Respiratory Research, Dr Jennifer Perret, from the university’s Allergy and Lung Health Unit, said the findings added to previous work showing that children with protracted bacterial bronchitis are at increased risk of serious chronic infective lung disease after two to five years.

Dr Perret said the numbers of children with the most severe bronchitis were small (just 42 participants were in this category and of these just 14 had current asthma in middle-age), but the trends across bronchitis severity categories were significant.

“Compared with the majority who never had from bronchitis, there was an incremental increase in risk for later asthma and pneumonia which strengthened the more often a person had suffered from bronchitis as a child, and especially if they had recurrent episodes which were prolonged for at least one month in duration,” she said.

“It is notable that the link with later adult active asthma was seen for participants who did not have co-existent asthma or wheezing in childhood, and a similar finding has been recently seen in a very large meta-analysis of school-aged children who had had a lower respiratory tract infection during early childhood.”

CFTR therapy protects against severe COVID

CFTR modulator therapies significantly reduced the odds of patients with cystic fibrosis (CF) from being hospitalised with supplemental oxygen due to COVID-19, a UK-led global study has found.

The research was based on 1,555 people with CF diagnosed with SARS-CoV-2 infection between February and December 2020 listed within national CF registers in 22 countries, before vaccines were licensed.

Sensitivity analysis in the non-transplant cohort, which involved patients from the US and UK only, showed a 59% reduction in risk of the primary outcome compared with no modulators.

“A protective effect was noted in those individuals who were on highly effective modulator therapy at the time of SARS-CoV-2 infection in this global cohort,” said authors of the paper, published in the Journal of Cystic Fibrosis and led by Dr Siobhan Carr, a consultant in paediatric respiratory medicine at Royal Brompton Hospital.

“This supports the policy that patients eligible for these medications should have immediate access to improve health and potentially protect against severe COVID-19 disease,” they added.

In multivariable analysis, having low lung function was associated with a greater risk of progression to severe COVID-19 disease, with the data showing that a pre-pandemic baseline best ppFEV1 <40% versus >70% was linked with a 9-times higher risk of being hospitalised with oxygen (adjusted odds ratio [AOR] 9.10).

Other factors linked with more severe disease in CF patients included older age (AOR 2.50), being of non-white race (AOR 2.69), having had organ transplantation (AOR 2.45) and having CF-related diabetes, according to findings.

Palliative care discussion best in later stages of ILD journey

Researchers have defined different stages in the interstitial lung disease (ILD) patient journey, and at which point discussions on palliative care interventions should be initiated.

The analysis, published in Palliative Medicine, is based on research that included ILD patients’ or carers’ perspectives on living with end-stage disease or palliative care.

From 12 studies that met the inclusion criteria, which included evidence from 266 people across five countries, researchers identified three interconnecting stages in the patient journey following diagnosis: information seeking, grief and acceptance, and fear of the future.

The research indicates that referral to palliative care “is most appropriate in the latter two stages”, after patients have adjusted to the diagnosis “and are thinking about navigating their disease journey in the future”, the researchers concluded.

Also, they said that palliative care referral should be prompted by significant changes in the patient’s health status, such chest infections, new symptoms, hospital admission, decline in physical functioning and initiation of oxygen.

However, as these developments will not always follow planned clinical review, it is key that patients are able to contact their clinical team to allow for timely discussion on potential investigations, treatment options and referral to palliative care, they stressed.

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