Example of mild clubbing in CFA typical breathing treatment for Cystic Fibrosis, using a nebulizer and the ThAIRapy Vest
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Cystic fibrosis

Cystic fibrosis (CF), also called mucoviscidosis, is an autosomal recessive hereditary disease of the exocrine glands. It affects the lungs, sweat glands and the digestive system. It causes chronic respiratory and digestive problems. more...

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Symptoms

The first manifestation of CF is sometimes meconium ileus, occuring in 16% of infants who develop CF.

Other symptoms of CF usually develop during early childhood. Both lungs and pancreas produce abnormally viscous mucus. This mucus begins to build up and starts to clog the opening to the pancreas and the lungs. The mucus in the lungs can become a growth medium for bacteria, resulting in chronic respiratory infections and eventual permanent damage to the lung tissue. A chronic and loose sounding cough is common in people with CF. These thick secretions also obstruct the pancreas, preventing digestive enzymes from reaching the intestines to help break down and absorb food. Frequent and foul smelling stools are often an early sign of CF along with fatty oil that is visible in the stool. This can compromise growth and overall nutrition if proper treatment to aid digestion is not utilized early in life. As lung function deteriorates, CF patients can develop pulmonary hypertension and eventually cor pulmonale. Death usually occurs from severe infection, pneumonia, or heart failure.

The disease can be diagnosed by symptoms such as a high salt concentration in a baby's sweat (via sweat test) or by genetic testing. Prior to genetic testing, a sweat test was the gold standard for diagnosis of CF. The disease can also be diagnosed prenatally through chorionic villus sampling or amniocentesis.

History and statistics

Cystic fibrosis was first described as a disease in the late 1930s by Dorothy Hansine Andersen. It is the most common genetic disease among people with European ancestry. Approximately one in every 25 people of European descent is a carrier of one of the cystic fibrosis mutations, having one normal gene and one CF gene. Since cystic fibrosis is recessive, both copies of the gene have to be CF genes to cause the symptoms that occur in about 1 in every 2500 children. The high incidence of this lethal gene can be explained by the fact that CF carriers, who don't show any symptoms, enjoy some protection against cholera, since the extreme water loss in the intestines is prevented. More recently, evidence suggests CF genes could give protection against typhoid fever. People from areas where cholera and typhoid fever are not problems show a much lower incidence of CF. Genetic counseling and genetic testing is recommended for families who may be carriers of cystic fibrosis.

In 1988, the first mutation for CF, ΔF508, was discovered by Francis Collins, Lap-Chee Tsui and John R. Riordan on the seventh chromosome of the human genome. Research has subsequently found over 1000 different mutations that may cause CF, however ΔF508 accounts for approximately 70% of CF patients in Europe (this percentage varies regionally).

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Physiological responses comparation and reproductibility of six minute walking test in cystic fibrosis and normal children
From CHEST, 10/1/05 by Cristiane C. Coelho

PURPOSE: The aim of this study was to investigate pulmonary and cardiovascular responses during the six minute walking test (6MWT) in cystic fibrosis and normal children and to assess the test-retest of 6MWT in the studied population.

METHODS: The subjects recruited were distributed in two groups: cystic fibrosis (CF) and normal group (NG). The study consisted the test-retest of 6MWT by comparing performance on two consecutive 6MWT in both groups. The children had a rest of 30 minutes between the tests. The responsiveness of the 6MWT was determined by assessing the ability of the test to detect changes in exercise capacity. The variables analyzed were distance walked during the test, heart rate overload (% of HR), oxygen saturation (SpO2) and Borg score.

RESULTS: A total of 28 children were recruited in this study, 18 boys and 10 girls. The mean age was 11.53 [+ or -] 2,60 and 10,72 [+ or -] 2,88 years for CF and NG respectively. The mean values for lung volumes were (FEV1= 86.34 [+ or -] 27.11; FRC=94.85 [+ or -] 25.19) for CF and (FEV1=100.99 [+ or -] 8.92; FRC=112.26 [+ or -] 15.56) for NG. The comparison between the groups showed that the distance walked (CF=577.57 [+ or -] 60.22 NG=673 [+ or -] 55.32; p=0.0004) and Borg score(CF=9.92-2.32 CN=12.42 [+ or -] 2.4; p=0.01) were statistically different. However, there were no differences in %HR (CF=72.46 [+ or -] 9.15 NG=72.54 [+ or -] 12.19; p=0,85) and SpO2 (CF=94.07 [+ or -] 5.16 CN=96.28 [+ or -] 2.12; p=0.13) between the groups. The test-retest in cystic fibrosis group showed a significant increase in the walk distance in the second test (p=0.012), the others variables analyzed did not change. In the normal children group just the Borg Score had a significant increase in the second test (p=0,019).

CONCLUSION: There was no difference in heart rate overload in the 6MWT in cystic fibrosis and normal children. However, the cystic fibrosis children had a lower perception of exercise intensity and walked concerning underwear distances when compared with normal children.

CLINICAL IMPLICATIONS: The 6MWT can be applied in cystic fibrosis children as in normal children, however, the cystic fibrosis children has to be previously familiarized with the test.

DISCLOSURE: Cristiane Coelho, None.

Cristiane C. Coelho MA * Dorcas C. Almeida BA Gisele C. Oliveira BA Roberta C. Pinto BA Ivana M. Oliveira MA Evanirso S. Aquino BS Uni-BH, PUC MInas-Betim, Belo Horizonte, Brazil

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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