BAL Tied to Early Bronchiectasis in Kids With Cystic Fibrosis

(HealthDay News) – There is a higher chance of early bronchiectasis in children with cystic fibrosis among those patients with neutrophil elastase activity in bronchoalveolar lavage (BAL) fluid early in life, according to a study published online May 21 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 17–22 in Philadelphia.

Peter D. Sly, MD, DSc, from the University of Queensland in Brisbane, Australia, and colleagues studied 127 consecutive infants with a diagnosis of cystic fibrosis following newborn screening. When the children were in stable clinical condition at 3 months and 1, 2, and 3 years of age, chest computed tomography (CT) and BAL were performed.

The researchers found that the point prevalence of bronchiectasis increased at each visit, from 29.3% at 3 months of age to 61.5% at 3 years. Risk factors for bronchiectasis included presentation of meconium ileus (odds ratio [OR], 3.17), respiratory symptoms at the time of CT and BAL (OR, 2.27), free neutrophil elastase activity in BAL fluid (OR, 3.02), and gas trapping on expiratory CT (OR, 2.05). Persistent bronchiectasis (seen on two or more sequential scans) was associated with free neutrophil elastase activity in BAL fluid at 3 months, with the odds seven times as high at 12 months of age and four times as high at 3 years.

“Neutrophil elastase activity in BAL fluid in early life was associated with early bronchiectasis in children with cystic fibrosis,” the authors write.

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