dc.contributor.author |
Wainwright, CE |
en |
dc.contributor.author |
Vidmar, S |
en |
dc.contributor.author |
Armstrong, DS |
en |
dc.contributor.author |
Byrnes, Catherine |
en |
dc.contributor.author |
Carlin, JB |
en |
dc.contributor.author |
Cheney, J |
en |
dc.contributor.author |
Cooper, PJ |
en |
dc.contributor.author |
Grimwood, K |
en |
dc.contributor.author |
Moodie, M |
en |
dc.contributor.author |
Robertson, CF |
en |
dc.contributor.author |
Tiddens, HA |
en |
dc.date.accessioned |
2012-03-01T19:37:40Z |
en |
dc.date.issued |
2011-07-13 |
en |
dc.identifier.citation |
AMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 306(2):163-171 13 Jul 2011 |
en |
dc.identifier.issn |
0098-7484 |
en |
dc.identifier.uri |
http://hdl.handle.net/2292/12451 |
en |
dc.description.abstract |
Context Early pulmonary infection in children with cystic fibrosis leads to increased morbidity and mortality. Despite wide use of oropharyngeal cultures to identify pulmonary infection, concerns remain over their diagnostic accuracy. While bronchoalveolar lavage (BAL) is an alternative diagnostic tool, evidence for its clinical benefit is lacking.Objective To determine if BAL-directed therapy for pulmonary exacerbations during the first 5 years of life provides better outcomes than current standard practice relying on clinical features and oropharyngeal cultures.Design, Setting, and Participants The Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) randomized controlled trial, recruiting infants diagnosed with cystic fibrosis through newborn screening programs in 8 Australasian cystic fibrosis centers. Recruitment occurred between June 1, 1999, and April 30, 2005, with the study ending on December 31, 2009.Interventions BAL-directed (n=84) or standard (n=86) therapy until age 5 years. The BAL-directed therapy group underwent BAL before age 6 months when well, when hospitalized for pulmonary exacerbations, if Pseudomonas aeruginosa was detected in oropharyngeal specimens, and after P aeruginosa eradication therapy. Treatment was prescribed according to BAL or oropharyngeal culture results.Main Outcome Measures Primary outcomes at age 5 years were prevalence of P aeruginosa on BAL cultures and total cystic fibrosis computed tomography (CF-CT) score (as a percentage of the maximum score) on high-resolution chest CT scan.Results Of 267 infants diagnosed with cystic fibrosis following newborn screening, 170 were enrolled and randomized, and 157 completed the study. At age 5 years, 8 of 79 children (10%) in the BAL-directed therapy group and 9 of 76 (12%) in the standard therapy group had P aeruginosa in final BAL cultures (risk difference, -1.7% [95% confidence interval, -11.6% to 8.1%]; P=.73). Mean total CF-CT scores for the BAL-directed therapy and standard therapy groups were 3.0% and 2.8%, respectively (mean difference, 0.19% [95% confidence interval, -0.94% to 1.33%]; P=.74).Conclusion Among infants diagnosed with cystic fibrosis, BAL-directed therapy did not result in a lower prevalence of P aeruginosa infection or lower total CF-CT score when compared with standard therapy at age 5 years. |
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dc.language |
English |
en |
dc.publisher |
American Medical Association (AMA) |
en |
dc.relation.ispartofseries |
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION |
en |
dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.
Details obtained from http://www.sherpa.ac.uk/romeo/issn/0098-7484/ |
en |
dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
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dc.subject |
Science & Technology |
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dc.subject |
Life Sciences & Biomedicine |
en |
dc.subject |
Medicine, General & Internal |
en |
dc.subject |
General & Internal Medicine |
en |
dc.subject |
RESOLUTION COMPUTED-TOMOGRAPHY |
en |
dc.subject |
OROPHARYNGEAL CULTURES |
en |
dc.subject |
AIRWAY INFLAMMATION |
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dc.subject |
YOUNG-CHILDREN |
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dc.subject |
DORNASE-ALPHA |
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dc.subject |
NEW-ZEALAND |
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dc.subject |
DISEASE |
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dc.subject |
INFANTS |
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dc.subject |
PREVALENCE |
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dc.subject |
MANAGEMENT |
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dc.title |
Effect of Bronchoalveolar Lavage-Directed Therapy on Pseudomonas aeruginosa Infection and Structural Lung Injury in Children With Cystic Fibrosis A Randomized Trial |
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dc.type |
Journal Article |
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dc.identifier.doi |
10.1001/jama.2011.954 |
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pubs.issue |
2 |
en |
pubs.begin-page |
163 |
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pubs.volume |
306 |
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dc.rights.holder |
Copyright: American Medical Association |
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dc.identifier.pmid |
21750293 |
en |
pubs.end-page |
171 |
en |
dc.rights.accessrights |
http://purl.org/eprint/accessRights/RestrictedAccess |
en |
pubs.subtype |
Article |
en |
pubs.elements-id |
215103 |
en |
pubs.org-id |
Medical and Health Sciences |
en |
pubs.org-id |
School of Medicine |
en |
pubs.org-id |
Paediatrics Child & Youth Hlth |
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dc.identifier.eissn |
1538-3598 |
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pubs.record-created-at-source-date |
2012-03-22 |
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pubs.dimensions-id |
21750293 |
en |