Changes in airway inflammation with pseudomonas eradication in early cystic fibrosis

• Published in: Journal of cystic fibrosis Vol. 20; no. 6; pp. 941 - 948
• Main Authors: Garratt, Luke W, Breuer, Oded, Schofield, Craig J, McLean, Samantha A, Laucirica, Daniel R, Tirouvanziam, Rabindra, Clements, Barry S, Kicic, Anthony, Ranganathan, Sarath, Stick, Stephen M, CF, on behalf of AREST
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2021
• Subjects: Biomarkers - blood; Bronchiectasis; Bronchiectasis - diagnostic imaging; Child; Child, Preschool; Cystic Fibrosis - diagnostic imaging; Cystic Fibrosis - microbiology; Disease Progression; Female; Humans; Infant; Inflammation; Leukocyte Elastase - blood; Male; Neutrophil elastase; P. aeruginosa; Persistent Infection; Prospective Studies; Pseudomonas Infections - complications; Pseudomonas Infections - drug therapy; Tomography, X-Ray Computed; CT; Inflammation; Neutrophil elastase; Bronchiectasis; P. aeruginosa
• ISSN: 1569-1993; 1873-5010
• DOI: 10.1016/j.jcf.2020.12.015

•Neutrophil elastase activity can persist in children after Pseudomonas eradication.•Persistent neutrophil elastase activity led to worse CT outcomes.•Persistent neutrophil elastase also increased risk of subsequent infection.•Anti-inflammatories should be considered as part of Pseudomonas eradication. Background: Neutrophil elastase is a significant risk factor for structural lung disease in cystic fibrosis, and Pseudomonas aeruginosa airway infection is linked with neutrophilic inflammation and substantial respiratory morbidity. We aimed to evaluate how neutrophil elastase (NE) activity changes after P. aeruginosa eradication and influences early disease outcomes. Methods: We assessed participants in the AREST CF cohort between 2000 and 2018 who had P. aeruginosa cultured from their routine annual bronchoalveolar lavage (BAL) fluid and who underwent eradication treatment and a post eradication BAL. Factors associated with persistent P. aeruginosa infection, persistent neutrophilic inflammation following eradication and worse structural lung disease one year post-eradication were evaluated. Results: Eighty-eight episodes (3 months to 6 years old) of P. aeruginosa infection were studied. Eradication was successful in 84.1% of episodes. Median activity of NE was significantly reduced post-eradication from 9.15 to 3.4 nM (p = 0.008) but persisted in 33 subjects. High post-eradication NE levels were associated with an increased risk for P. aeruginosa infection in the next annual visit (odds ratio=1.7, 95% confidence interval 1.1–2.7, p = 0.014). Post-eradication NE levels (difference, 0.8; 95% confidence interval, 0.1–1.5) and baseline bronchiectasis computed tomography (CT) score (difference, 0.4; 95% confidence interval, 0.1–0.8) were the best predictors of bronchiectasis progression within 1 year (backward stepwise linear regression model, R2= 0.608, P<0.001), independent of eradication. Conclusion: In children with CF, NE activity may persist following successful P. aeruginosa eradication and is significantly associated with bronchiectasis progression. Evaluating strategies to diminish neutrophilic inflammation is essential for improving long-term outcomes.