Comparative Evaluation of Clinical, Spiro/Oscillometric and Tomographic Parameters as a Global Assessment of Children with Cystic Fibrosis

INTRODUCTION: The aim of our study was to compare clinical severity scores and classic spirometry with impulse oscillometry (IOS) results and thoracic high-resolution computed tomography (HRCT) scores in children with Cystic fibrosis (CF) in order to determine the utility of the latter approach in patient follow-up.
METHODS: CF patients over 6 years of age were included. Swachman Kulczycki score, underclassical spirometry and IOS were performed when not in acute exacerbation. Thoracic HRCT images obtained within the previous 6 months were evaluated using the Bhalla scoring system.
RESULTS: The mean age of the children studied (n=30) was 12.1±4.2 years and 40% were female. Pseudomonas aeruginosa (P.aeroginosa) was isolated from sputum cultures of 40% of the patients. Patients with forced expiratory volume in 1 s (FEV1) below 80% exhibited significantly higher (resistance)R5, R10 values and significantly lower (reactance) X5 values on IOS (p=0.03, 0.027, 0.006, respectively). Patients with P.aeruginosa had significantly lower FEV1, FVC, and FEF25-75 values in classic spirometry when compared with patients without P.aeruginosa (p=0.002, p=0.002, and p=0.005, respectively). P. aeruginosa-positive patients showed significantly higher R5 and lower X5 values (p=0.047, 0.046, respectively). Bhalla scoring, bronchiectasis weight, peribronchial thickening, mucous plaques, saccularization, bronchial division, mosaic pattern parameters in groups with P.Aeroginosa growth and / or FEV1 <80%; was found to be significantly more serious than the non-reproductive group (p <0.005, respectively). Again, in the group with P. Aeroginosa growth, Swachman Kulczycki score was found to be significantly lower (p = 0.001). No significant correlation was found between thoracic score data such as bronchiectasis weight and mosaic pattern presence and impulse oscillometry values. In addition, in the group with high clinical score of swachman Kulczycki, resistance values such as R5 R10 R15, which are IOS parameters, and FEV1 were found above 80%. (p = 0.016, p = 0.037, p = 0.042, 0.004, respectively).
DISCUSSION AND CONCLUSION: Impulse oscillometry and tomographic scoring can be used safely in early detection of impairment in lung function. Further studies are needed to evaluate the utility of impulse oscillometry in the clinical monitoring of children with cystic fibrosis who are not compliant with spirometry maneuvers.