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dc.contributor.authorWainwright, Claire E
dc.contributor.authorVidmar, Suzanna
dc.contributor.authorArmstrong, David S
dc.contributor.authorByrnes, Catherine A
dc.contributor.authorCarlin, John B
dc.contributor.authorCheney, Joyce
dc.contributor.authorCooper, Peter J
dc.contributor.authorGrimwood, Keith
dc.contributor.authorMoodie, Marj
dc.contributor.authorRobertson, Colin F
dc.contributor.authorTiddens, Harm A
dc.date.accessioned2017-05-03T13:13:35Z
dc.date.available2017-05-03T13:13:35Z
dc.date.issued2011
dc.date.modified2014-06-16T04:41:35Z
dc.identifier.issn0098-7484
dc.identifier.doi10.1001/jama.2011.954
dc.identifier.urihttp://hdl.handle.net/10072/60290
dc.description.abstractContext Early pulmonary infection in children with cystic fibrosis leads to increased morbidity and mortality. Despite wide use of oropharyngeal cultures to identify pulmonary infection, concerns remain over their diagnostic accuracy. While bronchoalveolar lavage (BAL) is an alternative diagnostic tool, evidence for its clinical benefit is lacking. Objective To determine if BAL-directed therapy for pulmonary exacerbations during the first 5 years of life provides better outcomes than current standard practice relying on clinical features and oropharyngeal cultures. Design, Setting, and Participants The Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) randomized controlled trial, recruiting infants diagnosed with cystic fibrosis through newborn screening programs in 8 Australasian cystic fibrosis centers. Recruitment occurred between June 1, 1999, and April 30, 2005, with the study ending on December 31, 2009. Interventions BAL-directed (n = 84) or standard (n = 86) therapy until age 5 years. The BAL-directed therapy group underwent BAL before age 6 months when well, when hospitalized for pulmonary exacerbations, if Pseudomonas aeruginosa was detected in oropharyngeal specimens, and after P aeruginosa eradication therapy. Treatment was prescribed according to BAL or oropharyngeal culture results. Main Outcome Measures Primary outcomes at age 5 years were prevalence of P aeruginosa on BAL cultures and total cystic fibrosis computed tomography (CF-CT) score (as a percentage of the maximum score) on high-resolution chest CT scan. Results Of 267 infants diagnosed with cystic fibrosis following newborn screening, 170 were enrolled and randomized, and 157 completed the study. At age 5 years, 8 of 79 children (10%) in the BAL-directed therapy group and 9 of 76 (12%) in the standard therapy group had P aeruginosa in final BAL cultures (risk difference, -1.7% [95% confidence interval, -11.6% to 8.1%]; P = .73). Mean total CF-CT scores for the BAL-directed therapy and standard therapy groups were 3.0% and 2.8%, respectively (mean difference, 0.19% [95% confidence interval, -0.94% to 1.33%]; P = .74). Conclusion Among infants diagnosed with cystic fibrosis, BAL-directed therapy did not result in a lower prevalence of P aeruginosa infection or lower total CF-CT score when compared with standard therapy at age 5 years.
dc.description.peerreviewedYes
dc.description.publicationstatusYes
dc.languageEnglish
dc.language.isoeng
dc.publisherAmerican Medical Association
dc.publisher.placeUnited States
dc.relation.ispartofstudentpublicationN
dc.relation.ispartofpagefrom163
dc.relation.ispartofpageto171
dc.relation.ispartofissue2
dc.relation.ispartofjournalJAMA
dc.relation.ispartofvolume306
dc.rights.retentionY
dc.subject.fieldofresearchBiomedical and clinical sciences
dc.subject.fieldofresearchcode32
dc.titleEffect of Bronchoalveolar Lavage–Directed Therapy on Pseudomonas aeruginosa Infection and Structural Lung Injury in Children With Cystic Fibrosis: A Randomized Trial
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.hasfulltextNo Full Text
gro.griffith.authorGrimwood, Keith


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