<i>Aspergillus</i> and progression of lung disease in children with cystic fibrosis.

Abstract

The impact of <i>Aspergillus</i> on lung disease in young children with cystic fibrosis is uncertain. To determine if positive respiratory cultures of <i>Aspergillus</i> species are associated with: (1) increased structural lung injury at age 5 years; (2) accelerated lung function decline between ages 5 years and 14 years and (3) to identify explanatory variables. A cross-sectional analysis of association between <i>Aspergillus</i> positive bronchoalveolar lavage (BAL) cultures and chest high-resolution CT (HRCT) scan findings at age 5 years in subjects from the Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) study was performed. A non-linear mixed-effects disease progression model was developed using FEV₁% predicted measurements at age 5 years from the ACFBAL study and at ages 6-14 years for these subjects from the Australian Cystic Fibrosis Data Registry. Positive <i>Aspergillus</i> BAL cultures at age 5 years were significantly associated with increased HRCT scores for air trapping (OR 5.53, 95% CI 2.35 to 10.82). However, positive <i>Aspergillus</i> cultures were not associated with either FEV₁% predicted at age 5 years or FEV₁% predicted by age following adjustment for body mass index z-score and hospitalisation secondary to pulmonary exacerbations. Lung function demonstrated a non-linear decline in this population. In children with cystic fibrosis, positive <i>Aspergillus</i> BAL cultures at age 5 years were associated contemporaneously with air trapping but not bronchiectasis. However, no association was observed between positive <i>Aspergillus</i> BAL cultures on FEV₁% predicted at age 5 years or with lung function decline between ages 5 years and 14 years.