Modern Management of Cystic Fibrosis and Its Influence upon General
Health and Survival of Czech Patients
Zemková D.1, Skalická V.1, Bartošová J.1, Smolíková L.2, Brázová J.1, Fischerová T.1, Böhmová K.1, Pelikán L.1, Koloušková S.1, Chladová H.1, Dřevínek P.1, Macek M. ml.3, Pohunek P.1
Pediatrická klinika UK 2. LF a FN Motol, Praha1 přednosta prof. MUDr. J. Lebl, CSc. Klinika rehabilitace UK 2. LF a FN Motol, Praha2přednosta doc. PaedDr. P. Kolář Ústav biologie a lékařské genetiky UK 2. LF a FN Motol, Praha3přednosta prof. MUDr. M. Macek ml., DrSc. |
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Summary:
Cystic fibrosis is a severe multisystemic autosomal recessively inherited disease.
The disease becomes manifest with repeating respiratory tract infections, failure to
thrive, high concentrations of salt in the sweat, and other complications. Up to 98% of
adult men suffering from cystic fibrosis are infertile.
Management of cystic fibrosis must be complex, systematic, and should be managed
by an experienced team of specialists. The expensive treatment the authors describe
wasn’t fully accessible to patients until the year 1989. Comparing the status of patients
on different therapeutic regimes allows assessing the importance of modern treatment
and its influence upon nutritional status, lung function, and patient survival.
A group of 639 patients diagnosed between 1960 and June 6, 2007 at the CF Centre
of Faculty Hospital Motol, Prague, was divided into three cohorts according to year of
birth. Cohort I comprised 187 patients born before the year 1975. In cohort II are included
165 patients born between January 1, 1976 and December 31, 1985. Cohort III
consists of 287 patients born after January 1, 1986. Cohort III is further divided into
two subgroups.
Authors compared semi-longitudinal anthropometric and spirometric data in each
category using the t-test. The length of survival in each group was analysed using
Kaplan-Mayer’s function of survival and the cohorts were compared using the Long
Rank test.
High mortality rate, poor nutritional status, which especially worsened during
puberty, and growth retardation were characteristic for the oldest cohort. Modern treatment
methods applied in cohort II led to improvement of nutritional status, central
airway obstruction, and increased median of survival from 16.3 to 25.3 years. Modern
treatment from early childhood in cohort III led to improvement of peripheral airway
obstruction and a higher age of survival. Intensive treatment from early childhood
lowers mortality during childhood to a minimum.
Authors have proven that modern management of CF improves nutritional status,
lung function, and age of survival.
Key words:
cystic fibrosis, complex management, longitudinal follow-up, survival,
lung function, nutritional status
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