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Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging

Respiratory tract exacerbations play a crucial role in progressive lung damage of people with cystic fibrosis, representing a major determinant in the loss of functional lung tissue, quality of life and patient survival. Detection and monitoring of respiratory tract exacerbations are challenging for...

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Autores principales: Landini, Nicholas, Ciet, Pierluigi, Janssens, Hettie M., Bertolo, Silvia, Ros, Mirco, Mattone, Monica, Catalano, Carlo, Majo, Fabio, Costa, Stefano, Gramegna, Andrea, Lucca, Francesca, Parisi, Giuseppe Fabio, Saba, Luca, Tiddens, Harm A. W. M., Morana, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9940849/
https://www.ncbi.nlm.nih.gov/pubmed/36814432
http://dx.doi.org/10.3389/fped.2022.1084313
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author Landini, Nicholas
Ciet, Pierluigi
Janssens, Hettie M.
Bertolo, Silvia
Ros, Mirco
Mattone, Monica
Catalano, Carlo
Majo, Fabio
Costa, Stefano
Gramegna, Andrea
Lucca, Francesca
Parisi, Giuseppe Fabio
Saba, Luca
Tiddens, Harm A. W. M.
Morana, Giovanni
author_facet Landini, Nicholas
Ciet, Pierluigi
Janssens, Hettie M.
Bertolo, Silvia
Ros, Mirco
Mattone, Monica
Catalano, Carlo
Majo, Fabio
Costa, Stefano
Gramegna, Andrea
Lucca, Francesca
Parisi, Giuseppe Fabio
Saba, Luca
Tiddens, Harm A. W. M.
Morana, Giovanni
author_sort Landini, Nicholas
collection PubMed
description Respiratory tract exacerbations play a crucial role in progressive lung damage of people with cystic fibrosis, representing a major determinant in the loss of functional lung tissue, quality of life and patient survival. Detection and monitoring of respiratory tract exacerbations are challenging for clinicians, since under- and over-treatment convey several risks for the patient. Although various diagnostic and monitoring tools are available, their implementation is hampered by the current definition of respiratory tract exacerbation, which lacks objective “cut-offs” for clinical and lung function parameters. In particular, the latter shows a large variability, making the current 10% change in spirometry outcomes an unreliable threshold to detect exacerbation. Moreover, spirometry cannot be reliably performed in preschool children and new emerging tools, such as the forced oscillation technique, are still complementary and need more validation. Therefore, lung imaging is a key in providing respiratory tract exacerbation-related structural and functional information. However, imaging encompasses several diagnostic options, each with different advantages and limitations; for instance, conventional chest radiography, the most used radiological technique, may lack sensitivity and specificity in respiratory tract exacerbations diagnosis. Other methods, including computed tomography, positron emission tomography and magnetic resonance imaging, are limited by either radiation safety issues or the need for anesthesia in uncooperative patients. Finally, lung ultrasound has been proposed as a safe bedside option but it is highly operator-dependent and there is no strong evidence of its possible use during respiratory tract exacerbation. This review summarizes the clinical challenges of respiratory tract exacerbations in patients with cystic fibrosis with a special focus on imaging. Firstly, the definition of respiratory tract exacerbation is examined, while diagnostic and monitoring tools are briefly described to set the scene. This is followed by advantages and disadvantages of each imaging technique, concluding with a diagnostic imaging algorithm for disease monitoring during respiratory tract exacerbation in the cystic fibrosis patient.
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spelling pubmed-99408492023-02-21 Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging Landini, Nicholas Ciet, Pierluigi Janssens, Hettie M. Bertolo, Silvia Ros, Mirco Mattone, Monica Catalano, Carlo Majo, Fabio Costa, Stefano Gramegna, Andrea Lucca, Francesca Parisi, Giuseppe Fabio Saba, Luca Tiddens, Harm A. W. M. Morana, Giovanni Front Pediatr Pediatrics Respiratory tract exacerbations play a crucial role in progressive lung damage of people with cystic fibrosis, representing a major determinant in the loss of functional lung tissue, quality of life and patient survival. Detection and monitoring of respiratory tract exacerbations are challenging for clinicians, since under- and over-treatment convey several risks for the patient. Although various diagnostic and monitoring tools are available, their implementation is hampered by the current definition of respiratory tract exacerbation, which lacks objective “cut-offs” for clinical and lung function parameters. In particular, the latter shows a large variability, making the current 10% change in spirometry outcomes an unreliable threshold to detect exacerbation. Moreover, spirometry cannot be reliably performed in preschool children and new emerging tools, such as the forced oscillation technique, are still complementary and need more validation. Therefore, lung imaging is a key in providing respiratory tract exacerbation-related structural and functional information. However, imaging encompasses several diagnostic options, each with different advantages and limitations; for instance, conventional chest radiography, the most used radiological technique, may lack sensitivity and specificity in respiratory tract exacerbations diagnosis. Other methods, including computed tomography, positron emission tomography and magnetic resonance imaging, are limited by either radiation safety issues or the need for anesthesia in uncooperative patients. Finally, lung ultrasound has been proposed as a safe bedside option but it is highly operator-dependent and there is no strong evidence of its possible use during respiratory tract exacerbation. This review summarizes the clinical challenges of respiratory tract exacerbations in patients with cystic fibrosis with a special focus on imaging. Firstly, the definition of respiratory tract exacerbation is examined, while diagnostic and monitoring tools are briefly described to set the scene. This is followed by advantages and disadvantages of each imaging technique, concluding with a diagnostic imaging algorithm for disease monitoring during respiratory tract exacerbation in the cystic fibrosis patient. Frontiers Media S.A. 2023-02-06 /pmc/articles/PMC9940849/ /pubmed/36814432 http://dx.doi.org/10.3389/fped.2022.1084313 Text en © 2023 Landini, Ciet, Janssen, Bertolo, Ros, Mattone, Catalano, Majo, Costa, Gramegna, Lucca, Parisi, Saba, Tiddens and Morana. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Landini, Nicholas
Ciet, Pierluigi
Janssens, Hettie M.
Bertolo, Silvia
Ros, Mirco
Mattone, Monica
Catalano, Carlo
Majo, Fabio
Costa, Stefano
Gramegna, Andrea
Lucca, Francesca
Parisi, Giuseppe Fabio
Saba, Luca
Tiddens, Harm A. W. M.
Morana, Giovanni
Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging
title Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging
title_full Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging
title_fullStr Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging
title_full_unstemmed Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging
title_short Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging
title_sort management of respiratory tract exacerbations in people with cystic fibrosis: focus on imaging
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9940849/
https://www.ncbi.nlm.nih.gov/pubmed/36814432
http://dx.doi.org/10.3389/fped.2022.1084313
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