Cystic Fibrosis Health Article

Respiratory health

The key to maintaining respiratory health in a person with CF is regular monitoring and early treatment. Lung function tests are done frequently to track changes in functional lung volume and respiratory effort. Sputum samples are analyzed to determine the types of bacteria present in the lungs. Chest x rays are usually taken at least once a year. Lung scans, using a radioactive gas, can show closed off areas not seen on the x ray. Circulation in the lungs may be monitored by injection of a radioactive substance into the bloodstream.

People with CF live with chronic bacterial colonization; that is, their lungs are constantly host to several species of bacteria. Good general health, especially good nutrition, can keep the immune system healthy, which decreases the frequency with which these colonies begin an infection, or attack on the lung tissue. Exercise is another important way to maintain health, and people with CF are encouraged to maintain a program of regular exercise.

In addition, clearing mucus from the lungs helps to prevent infection; and mucus control is an important aspect of CF management. Postural drainage is used to allow gravity to aid the mucociliary escalator. For this technique, the person with CF lies on a tilted surface with head downward, alternately on the stomach, back, or side, depending on the section of lung to be drained. An assistant thumps the rib cage to help loosen the secretions. A device called a "flutter" offers another way to loosen secretions: it consists of a stainless steel ball in a tube. When a person exhales through it, the ball vibrates, sending vibrations back through the air in the lungs. Some special breathing techniques may also help clear the lungs.

Several drugs are available to prevent the airways from becoming clogged with mucus. Bronchodilators and theophyllines open up the airways; steroids reduce inflammation; and mucolytics loosen secretions. Acetylcysteine (Mucomyst) has been used as a mucolytic for many years but is not prescribe frequently now, while DNase (Pulmozyme) is a newer product gaining in popularity. DNase breaks down the DNA from dead white blood cells and bacteria found in thick mucus.

People with CF may pick up bacteria from other CF patients. This is especially true of Burkholderia cepacia, which is not usually found in people without CF. While the ideal recommendation from a health standpoint might be to avoid contact with others who have CF, this is not usually practical (since CF clinics are a major site of care), nor does it meet the psychological and social needs of many people with CF. At a minimum, CF centers recommend avoiding prolonged close contact between people with CF, and scrupulous hygiene, including frequent hand washing. Some CF clinics schedule appointments on different days for those with and without B. cepacia colonies.

Some doctors choose to prescribe antibiotics only during infection, while others prefer long-term antibiotic treatment against S. aureus. The choice of antibiotic depends on the particular organism or organisms found. Some antibiotics are given as aerosols directly into the lungs. Antibiotic treatment may be prolonged and aggressive.

Supplemental oxygen may be needed as lung disease progresses. Respiratory failure may develop, requiring temporary use of a ventilator to perform the work of breathing.

Lung transplantation has become increasingly common for people with CF, although the number of people who receive them is still much lower than those who want them. Transplantation is not a cure, however, and has been likened to trading one disease for another. Long-term immunosuppression is required, increasing the likelihood of other types of infection. About 50% of adults and more than 80% of children who receive lung transplants live longer than two years. Liver transplants are also done for CF patients whose livers have been damaged by fibrosis.

Long-term use of ibuprofen has been shown to help some people with CF, presumably by reducing inflammation in the lungs. Close medical supervision is necessary, however, since the effective dose is high and not everyone benefits. Ibuprofen at the required doses interferes with kidney function, and together with aminoglycoside antibiotics, may cause kidney failure.

A number of experimental treatments are currently the subject of much research. Some evidence indicates that aminoglycoside antibiotics may help overcome the genetic defect in some CF mutations, allowing the protein to be made normally. While promising, these results would apply to only about 5% of those with CF.

Gene therapy is currently the most ambitious approach to curing CF. In this set of techniques, nondefective copies of the CFTR gene are delivered to affected cells, where they are taken up and used to create the CFTR protein. While elegant and simple in theory, gene therapy has met with a large number of difficulties in trials so far, including immune resistance, very short duration of the introduced gene, and inadequately widespread delivery.