Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study.

BACKGROUND: Handheld spirometry allows monitoring of lung function at home, of particular importance during the COVID-19 pandemic. Pediatric studies are unclear on whether values are interchangeable with traditional, clinic-based spirometry. We aimed to assess differences between contemporaneous, home (unsupervised) and clinic (supervised) spirometry and the variability of the former. The accuracy of the commercially available spirometer used in the study was also tested. METHODS: Data from participants in the Clinical Monitoring and Biomarkers to stratify severity and predict outcomes in children with cystic fibrosisc (CLIMB-CF) Study aged ≥ 6 years who had paired (±1 day) clinic and home forced expiratory volume in 1 s (FEV1 ) readings were analyzed. Variability during clinical stability over 6-months was assessed. Four devices from Vitalograph were tested using 1 and 3 L calibration syringes. RESULTS: Sixty-seven participants (median [interquartile range] age 10.7 [7.6-13.9] years) provided home and clinic FEV1 data pairs. The mean (SD) FEV1 % bias was 6.5% [±8.2%]) with wide limits of agreement (-9.6% to +22.7%); 76.2% of participants recorded lower results at home. Coefficient of variation of home FEV1 % during stable periods was 9.9%. Data from the testing of the handheld device used in CLIMB-CF showed a potential underread. CONCLUSION: In children and adolescents, home spirometry using hand-held equipment cannot be used interchangeably with clinic spirometry. Home spirometry is moderately variable during clinical stability. New handheld devices underread, particularly at lower volumes of potential clinical significance for smaller patients; this suggests that supervision does not account fully for the discrepancy. Opportunities should be taken to obtain dual device measurements in clinic, so that trend data from home can be utilized more accurately.

Estimation of GFR in Patients With Cystic Fibrosis: A Cross-Sectional Study.

BACKGROUND: Patients with cystic fibrosis (CF) have frequent infectious complications requiring nephrotoxic medications, necessitating monitoring of renal function. Although adult studies have suggested that cystatin C (CysC)-based estimated glomerular filtration rate (eGFR) may be preferable due to reduced muscle mass of patients with CF, pediatric patients remain understudied. OBJECTIVE: Our objective was to determine which eGFR formula is best for estimating glomerular filtration rate (GFR) in pediatric patients with CF. METHODS: A total of 17 patients with CF treated with nephrotoxic antibiotics were recruited from the Children's Hospital at London Health Sciences Centre, London, Ontario, Canada. 99Tc DTPA GFR (measured GFR [mGFR]) was measured with 4-point measurements starting at 120 minutes using a 2-compartmental model with Brøchner-Mortensen correction, with simultaneous measurement of creatinine, urea, and CysC. The eGFR was calculated using 16 known equations based on creatinine, urea, CysC, or combinations of these. Primary outcome measures were correlation with mGFR, and agreement within 10% for various eGFR equations. RESULTS: Mean mGFR was 136 ± 21 mL/min/1.73 m2. Mean creatinine, CysC, and urea were 38 ± 10 µmol/L, 0.72 ± 0.08 mg/L, and 3.9 ± 1.4 mmol/L, respectively. The 2014 Grubb CysC eGFR had the best correlation coefficient (r = 0.75, P = .0004); however, only 35% were within 10%. The new Schwartz formula with creatinine and urea had the best agreement within 10%, but a relatively low correlation coefficient (r = 0.63, P = .0065, 64% within 10%). CONCLUSIONS: Our study suggests that none of the eGFR formulae work well in this small cohort of pediatric patients with CF with preserved body composition, possibly due to inflammation causing false elevations of CysC. Based on the small numbers, we cannot conclude which eGFR formula is best.

CONTEXTE: Les complications infectieuses nécessitant un traitement néphrotoxique sont fréquentes chez les patients atteints de fibrose kystique (FK), ce qui exige une surveillance de leur fonction rénale. Quoique des études chez l'adulte suggèrent qu'en raison de la réduction de la masse musculaire, la mesure du DFGe basée sur la cystatine C (Cys-C) serait la méthode à privilégier, les patients pédiatriques demeurent sous-étudiés. OBJECTIF: Déterminer la meilleure formule de calcul pour estimer le DFG chez les enfants atteints de FK. MÉTHODOLOGIE: Au total, 17 patients atteints de FK et traités avec des antibiotiques néphrotoxiques ont été recrutés à l'hôpital pour enfants du London Health Sciences Centre de London (Ontario, Canada). Le DFG mesuré par 99Tc DTPA (mDFG) a été mesuré en quatre points à partir de 120 minutes avec un modèle à deux compartiments, en appliquant la correction de Brøchner-Mortenson. Les taux de créatinine, d'urée et de CysC ont été mesurés simultanément. Le DFGe a été calculé à l'aide de 16 équations connues basées sur la créatinine, l'urée et la Cys-C, ou sur une combinaison de ces éléments. Les principales mesures de résultats étaient une corrélation avec le mDFG et une concordance à l'intérieur de 10 % avec les valeurs de plusieurs équations de DFGe. RÉSULTATS: Le mDFG moyen s'établissait à 136 ±2 ml/min/1,73 m2. Les taux moyens de créatinine, de Cys-C et d'urée étaient respectivement de 38 ±10 umol/L, 0,72 ±0,08 mg/L et 3,9 ±1,4 mmol/L. Le DFG obtenu par l'équation de Grubb 2014 avec la CysC présentait le meilleur coefficient de corrélation (r=0,75, p=0,0004), mais seulement 35 % des valeurs avaient une concordance à l'intérieur des 10 %. La nouvelle formule de Schwartz avec la créatinine et l'urée a obtenu le pourcentage le plus élevé de concordance à l'intérieur des 10 %, mais son coefficient de corrélation était relativement faible (r=0,63, p=0,0065, 64% des valeurs à l'intérieur des 10%). CONCLUSION: Ces résultats suggèrent qu'aucune des formules de calcul du DFGe testées n'a bien fonctionné dans notre cohorte d'enfants atteints de FK avec une constitution physique préservée, possiblement en raison d'une inflammation provoquant une élévation du taux de Cys-C. Compte tenu de ces résultats, nous ne pouvons déterminer laquelle parmi ces formules de DFGe est la meilleure.

Complementary and alternative medicine use in children with asthma.

PURPOSE: To estimate the overall prevalence of complementary and alternative medicine and specific modalities used among children with asthma, identify predictors of use, and perceived positive or negative effects of therapies. RESULTS: Of the 161 children enrolled in the study, 76.4% had ever used complementary and alternative medicine. Humidifiers, air purifiers, and multivitamins were the most common modalities used. Complementary and alternative medicine use in children was associated with family use, younger child age, and disease severity, indicated by recent asthma exacerbation. The majority of participants perceived benefit from their complementary and alternative medicine use, with very few reporting negative side effects. Only 36.7% of participants reported discussing their complementary and alternative medicine use with the asthma clinic healthcare team. CONCLUSIONS: The prevalence of complementary and alternative medicine use in children with asthma is high, with the majority of families perceiving benefit from its use. This study offers clinicians a reference to inform families regarding the subjective helpfulness of various types of complementary and alternative medicine modalities that can facilitate the dialogue between health care professionals and families interested in complementary and alternative medicine use.

Complementary and alternative medicine use in children with cystic fibrosis.

PURPOSE: To estimate the overall prevalence of complementary and alternative medicine use among children with cystic fibrosis, determine specific modalities used, predictors of use and subjective helpfulness or harm from individual modalities. RESULTS: Of 53 children attending the cystic fibrosis clinic in London, Ontario (100% recruitment), 79% had used complementary and alternative medicine. The most commonly used modalities were air purifiers, humidifiers, probiotics, and omega-3 fatty acids. Family complementary and alternative medicine use was the only independent predictor of overall use. The majority of patients perceived benefit from specific modalities for cystic fibrosis symptoms. CONCLUSIONS: Given the high frequency and number of modalities used and lack of patient and disease characteristics predicting use, we recommend that health care providers should routinely ask about complementary and alternative medicine among all pediatric cystic fibrosis patients and assist patients in understanding the potential benefits and risks to make informed decisions about its use.