Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Sep 17;9(9):CD009530.
doi: 10.1002/14651858.CD009530.pub4.

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis

Kamini Jain  1 , Claire Wainwright, Alan R Smyth
Affiliations
Review

Bronchoscopy-guided antimicrobial therapy for cystic fibrosis

Kamini Jain et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Early diagnosis and treatment of lower respiratory tract infections are the mainstay of management of lung disease in cystic fibrosis. When sputum samples are unavailable, treatment relies mainly on cultures from oropharyngeal specimens; however, there are concerns regarding the sensitivity of these to identify lower respiratory organisms.Bronchoscopy and related procedures (including bronchoalveolar lavage) though invasive, allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may help in a more accurate diagnosis of lower respiratory tract infections and guide the selection of antimicrobials, which may lead to clinical benefits.This is an update of a previous review.

Objectives: To evaluate the use of bronchoscopy-guided antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis.

Search methods: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of latest search: 30 August 2018.We also searched three registries of ongoing studies and the reference lists of relevant articles and reviews. Date of latest search: 10 April 2018.

Selection criteria: We included randomized controlled studies including people of any age with cystic fibrosis, comparing outcomes following therapies guided by the results of bronchoscopy (and related procedures) with outcomes following therapies guided by the results of any other type of sampling (including cultures from sputum, throat swab and cough swab).

Data collection and analysis: Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information. The quality of the evidence was assessed using the GRADE criteria.

Main results: The search identified 11 studies, but we only included one study enrolling infants with cystic fibrosis under six months of age and diagnosed through newborn screening (170 enrolled); participants were followed until they were five years old (data from 157 children). The study compared outcomes following therapy directed by bronchoalveolar lavage for pulmonary exacerbations with standard treatment based on clinical features and oropharyngeal cultures.We considered this study to have a low risk of bias; however, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was limited due to the prevalence (of Pseudomonas aeruginosa isolation in bronchoalveolar lavage samples at five years age) being much lower in both the groups compared to that which was expected and which was used for the power calculation. The sample size was adequate to detect a difference in high-resolution computed tomography scoring. The quality of evidence for the key parameters was graded as low except high-resolution computed tomography scoring and cost of care analysis, which were graded as moderate quality.At five years of age, there was no clear benefit of bronchoalveolar lavage-directed therapy on lung function z scores or nutritional parameters. Evaluation of total and component high-resolution computed tomography scores showed no significant difference in evidence of structural lung disease in the two groups.In addition, this study did not show any difference between the number of isolates of Pseudomonas aeruginosa per child per year diagnosed in the bronchoalveolar lavage-directed therapy group compared to the standard therapy group. The eradication rate following one or two courses of eradication treatment was comparable in the two groups, as were the number of pulmonary exacerbations. However, the number of hospitalizations was significantly higher in the bronchoalveolar lavage-directed therapy group, but the mean duration of hospitalizations was significantly less compared to the standard therapy group.Mild adverse events were reported in a proportion of participants, but these were generally well-tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of bronchoalveolar lavage in 4.8% of procedures.

Authors' conclusions: This review, limited to a single, well-designed randomized controlled study, shows no clear evidence to support the routine use of bronchoalveolar lavage for the diagnosis and management of pulmonary infection in pre-school children with cystic fibrosis compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence was available for adult and adolescent populations.

PubMed Disclaimer

Conflict of interest statement

Kamini Jain declares no known potential conflict of interest.

Claire Wainwright has received research grants from the NHMRC, GlaxoSmithKline and Novo Nordisk Pharmaceuticals P/L. Her institution has received income on a per patient basis from pharmaceutical studies (Vertex Pharmaceuticals Inc., Boehringer‐Ingelheim & Ablynx NV). Dr Wainwright has been a consultant on the Vertex Physician Pediatric CF Advisory Board and the Vertex Innovation Awards (VIA) Grants Committee and is currently on the board of the International Advisory Board Vertex Pharmaceuticals P/L. She has received travel and accommodation expenses from Vertex Pharmaceuticals Inc and Novartis Pharmaceuticals. Payments for all items listed above have been made into an institutional consultancy fund account.

Alan R Smyth declares relevant activities of membership of consultancies for Vertex and PTC, and lectures paid for by PTC, Vertex, Teva, Novartis.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 1 Z score FEV1.
1.2
1.2. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 2 Z score FVC.
1.3
1.3. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 3 Total CF‐CT score (Brody‐II).
1.4
1.4. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 4 Individual CF‐CT scores (at 5 years).
1.5
1.5. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 5 Z score for weight.
1.6
1.6. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 6 Z score BMI.
1.7
1.7. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 7 Positive P aeruginosa isolates per patient per year.
1.8
1.8. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 8 Prevalence of P aeruginosa in BAL at 5 years age.
1.9
1.9. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 9 Sensitivity analysis ‐ Prevalence of P aeruginosa in BAL at 5 years age (40% vs 5%).
1.10
1.10. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 10 Sensitivity analysis ‐ Prevalence of P aeruginosa in BAL at 5 years age (5% vs 40%).
1.11
1.11. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 11 Clearance of P aeruginosa after 1 or 2 eradication treatments.
1.12
1.12. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 12 Age at first acquisition of P aeruginosa infection.
1.13
1.13. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 13 Number of hospital admissions per patient per year.
1.14
1.14. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 14 Number of hospitalizations per person per year due to non‐P aeruginosa exacerbations.
1.15
1.15. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 15 Duration of hospital admissions due to non‐P aeruginosa exacerbations.
1.16
1.16. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 16 Days as hospital inpatient per patient per year.
1.17
1.17. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 17 Total cost of care per participant (Australian Dollars).
1.18
1.18. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 18 Mean hospital admissions cost per patient.
1.19
1.19. Analysis
Comparison 1 BAL‐directed therapy versus standard therapy, Outcome 19 Number of pulmonary exacerbations (requiring oral or intravenous antibiotics) per patient per year.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Wainwright 2011 {published data only}
    1. Byrnes CA, Vidmar S, Cheney JL, Carlin JB, Armstrong DS, Cooper PJ, et al. Prospective evaluation of respiratory exacerbations in children with cystic fibrosis from newborn screening to 5 years of age. Thorax 2013;68(7):643‐51. [CFGD Register: PE167i] - PMC - PubMed
    1. Cheney J, Vidmar S, Grimwood K, Carlin JB, Wainwright C, on behalf of ACFBAL Study Group. Interim outcomes of a Pseudomonas aeruginosa (Pa) eradication protocol in young children in the Australian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) Study. Journal of Cystic Fibrosis 2009;8(Suppl 2):S39. [Abstract no.: 157; CFGD Register: PE167c]
    1. Cheney J, Wainwright C, ACFBAL SG. Trials, tribulations and triumphs of a cystic fibrosis study ‐ a behind the scenes look at the workings of an international multi‐centre study. Journal of Cystic Fibrosis 2010;9 Suppl 1:S118. [Abstract no.: 452; CFGD Register: PE167g; ]
    1. Kidd TJ, Ramsay KA, Vidmar S, Carlin JB, Bell SC, Wainwright CE, et al. Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5 years. Journal of Cystic Fibrosis 2015;14(3):361‐9. [CFGD Register: PE167k] - PubMed
    1. Moodie M, Lal A, Vidmar S, Armstrong DS, Byrnes CA, Carlin JB, et al. Costs of bronchoalveolar lavage‐directed therapy in the first 5 years of life for children with cystic fibrosis. Journal of Pediatrics 2014;165(3):564‐9. [CFGD Register: PE167j; CRS: 5500131000000365; JID:: 0375410; PUBMED: 24996984; SI:: ANZCTR/ACTRN12605000665639] - PubMed

References to studies excluded from this review

Chmiel 2015 {published data only}
    1. Chmiel JF, Konstan MW, Accurso FJ, Lymp J, Mayer‐Hamblett N, VanDevanter DR, et al. Use of ibuprofen to assess inflammatory biomarkers in induced sputum: implications for clinical trials in cystic fibrosis. Journal of Cystic Fibrosis 2015;14(6):720‐6. [CFGD Register: PI218b] - PubMed
    1. Chmiel JF, Konstan MW, Lymp J, Mayer‐Hamblett N, Hilliard KA, Accurso FJ, et al. Assessment of induced sputum as a tool to evaluate anti‐inflammatory agents in CF. Pediatric Pulmonology 2007;42 Suppl 30:228. [CFGD Register: PI218a]
Henig 2001 {published data only}
    1. Henig NR, Tonelli MR, Pier MV, Burns JL, Aitken ML. Sputum induction as a research tool for sampling the airways of subjects with cystic fibrosis. Pediatric Pulmonology 1999;28 Suppl 19:312‐3. [CFGD Register: PI225] - PMC - PubMed
    1. Henig NR, Tonelli MR, Pier MV, Burns JL, Aitken ML. Sputum induction as a research tool for sampling the airways of subjects with cystic fibrosis. Thorax 2001;56(4):306‐11. - PMC - PubMed
ISRCTN 12473810 {unpublished data only}
    1. ISRCTN 12473810. Induced sputum in children with cystic fibrosis. www.isrctn.com/ISRCTN12473810 (first received 03 January 2018).
Jyothish 2005 {published data only}
    1. Jyothish D, Desai M, Clarke JR, Weller PH, Gray J. Comparison of Cough Plates with Cough Swabs for identifying lower respiratory tract pathogens in children with Cystic Fibrosis. American Thoracic Society International Conference; 2005 May 20‐25; San Diego, USA. 2005:C16. [CFGD Register: PI192a]
    1. Jyothish D, Desai M, Clarke JR, Weller PH, Gray J. Use of cough plates for identifying lower respiratory tract pathogens in children with cystic fibrosis. Journal of Cystic Fibrosis 2005;4 Suppl:S40. [CFGD Register: PI192b]
Maiya 2004 {published data only}
    1. Maiya S, Desai M, Baruah A, Clarke J, Weller P, Gray J. Cough plate versus cough swab. Journal of Cystic Fibrosis 2002;1 Suppl 1:S122. [CFGD Register: PI168a] - PMC - PubMed
    1. Maiya S, Desai M, Baruah A, Weller P, Clarke JR, Gray J. Cough plate versus cough swab in patients with cystic fibrosis; a pilot study. Archives of Disease in Childhood 2004;89(6):577‐9. [CFGD Register: PI168b] - PMC - PubMed
McGarvey 2002 {published data only}
    1. McGarvey LPA, Dunbar K, Martin SL, Brown V, MacMahon J, Ennis M, et al. Cytokine concentrations and neutrophil elastase activity in bronchoalveolar lavage and induced sputum from patients with cystic fibrosis, mild asthma and healthy volunteers. Journal of Cystic Fibrosis 2002; Vol. 1, issue 4:269‐75. [CFGD Register: PI217] - PubMed
NCT02363764 {unpublished data only}
    1. NCT02363764. The challenge of obtaining qualitative bacterial cultures in non‐expectorating cystic fibrosis patients. clinicaltrials.gov/ct2/show/NCT02363764 (first received 16 February 2016).
Paul 2004 {published data only}
    1. Griese M, Essl R, Schmidt R, Ballmann M, Paul K, Rietschel E, et al. Sequential analysis of surfactant, lung function and inflammation in cystic fibrosis patients. Respiratory Research 2005;6:133. [CFGD Register: IB21i] - PMC - PubMed
    1. Jung A, Shute JK, Chen CIU, Ballmann M, Griese M, Ratjen F, et al. Influence of long‐term inhaled rhDNase on free and total IL‐8 concentration in BAL fluid in cystic fibrosis. 12th European Respiratory Society Annual Congress; 2002 Sept 14‐18; Stockholm. 2002:P3285. [CFGD Register: IB21d]
    1. Paul K, Ballmann M, Griese M, Rietschel E, Chen C, Schink T, et al. Effect of rhDNase on endobronchial inflammation in CF patients with mild lung disease: Results of the multi‐center BEAT study. Pediatric Pulmonology 2002;34 Suppl 24:310‐1. [CFGD Register: IB21c]
    1. Paul K, Rietschel E, Ballmann M, Griese M, Worlitzsch D, Shute J, et al. Effect of treatment with dornase alpha on airway inflammation in patients with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2004;169(6):719‐25. [CFGD Register: IB21f] - PubMed
    1. Paul KP, Ballmann M, Döring G, Griese M, Kleinau I, Ratjen F, et al. Airway inflammation in CF patients with good pulmonary function ‐ baseline data from the multicenter "BEAT" study. Pediatric Pulmonology 1998;26 Suppl 17:383‐4. [CFGD Register: IB21a]
Rosenfeld 2006 {published data only}
    1. Rosenfeld M, Emerson J, Uh D, Anderson G, Genatossio A, McNamara S, et al. Does tobramycin accumulate in respiratory secretions with repeated aerosol administration: a pilot study. Pediatric Pulmonology 2006;41 Suppl 29:327. [CFGD Register: PI203]
Taylor 2006 {published data only}
    1. Taylor L, Corey M, Matlow A, Geremia J, Sweezey N. Nasopharyngeal auger suction vs throat swab cultures in CF patients [abstract]. Pediatric Pulmonology 1998;26 Suppl 17:399. [CFGD Register: PI147a]
    1. Taylor L, Corey M, Matlow A, Sweezey NB, Ratjen F. Comparison of throat swabs and nasopharyngeal suction specimens in non‐sputum‐producing patients with cystic fibrosis. Pediatric Pulmonology 2006;41(9):839‐43. [CFGD Register: PI147b] - PubMed

Additional references

Armstrong 1995
    1. Armstrong DS, Grimwood K, Carzino R, Carlin JB, Olinsky A, Phelan PD. Lower respiratory infection and inflammation in infants with newly diagnosed cystic fibrosis. BMJ 1995;310(6994):1571‐2. - PMC - PubMed
Aurora 2005
    1. Aurora P, Bush A, Gustafsson P, Oliver C, Wallis C, Price J, et al. Multiple‐breath washout as a marker of lung disease in preschool children with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2005;171(3):249‐56. - PubMed
Baughman 1997
    1. Baughman RP, Keeton DA, Perez C, Wilmott RW. Use of bronchoalveolar lavage semi‐quantitative cultures in cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 1997;156(1):286‐91. - PubMed
Bobadilla 2002
    1. Bobadilla JL, Macek M Jr, Fine JP, Farrell PM. Cystic fibrosis: a worldwide analysis of CFTR mutations‐‐correlation with incidence data and application to screening. Human Mutation 2002;19(6):575‐606. - PubMed
Brody 2004
    1. Brody AS, Klein JS, Molina PL, Quan J, Bean JA, Wilmott RW. High‐resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests. Journal of Pediatrics 2004;145(1):32‐8. - PubMed
Dankert‐Roelse 2009
    1. Dankert‐Roelse JE, Merelle ME. Review of outcomes of neonatal screening for cystic fibrosis versus non‐screening in Europe. Journal of Pediatrics 2009;147(3 Suppl):S15‐20. - PubMed
de Blic 2002
    1. Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. European Respiratory Journal 2002;20(5):1271‐6. - PubMed
Deeks 2011
    1. Deeks J, Higgins J, Altman D. Chapter 9 Analysing data and undertaking meta‐analysis. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Dodge 2007
    1. Dodge JA, Lewis PA, Stanton M, Wilsher J. Cystic fibrosis mortality and survival in the UK: 1947‐2003. European Respiratory Journal 2007;29(3):522‐6. - PubMed
Farrell 1997a
    1. Farrell PM, Kosorok MR, Laxova A, Shen G, Koscik RE, Bruns WT, et al. Nutritional benefits of neonatal screening for cystic fibrosis. Wisconsin Cystic Fibrosis Neonatal Screening Study Group. New England Journal of Medicine 1997;337(14):963‐9. - PubMed
Farrell 1997b
    1. Farrell PM, Shen G, Splaingard M, Colby CE, Laxova A, Kosorok MR, et al. Acquisition of Pseudomonas aeruginosa in children with cystic fibrosis. Pediatrics 1997;100(5):E2. [DOI: 10.1542/peds.100.5.e2] - DOI - PubMed
Frederiksen 1997
    1. Frederiksen B, Koch C, Hoiby N. Antibiotic treatment of initial colonization with Pseudomonas aeruginosa postpones chronic infection and prevents deterioration of pulmonary function in cystic fibrosis. Pediatric Pulmonology 1997;23(5):330‐5. - PubMed
Gee 2000
    1. Gee L, Abbott J, Conway S, Etherington C, Webb A. Development of a disease specific health related quality of life measure for adults and adolescents with cystic fibrosis. Thorax 2000;55(11):946‐54. - PMC - PubMed
Gibson 2003
    1. Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. American Journal of Respiratory and Criticial Care Medicine 2003;168(8):918‐51. - PubMed
Gilchrist 2011
    1. Gilchrist FJ, Salamat S, Clayton S, Peach J, Alexander J, Lenney W. Bronchoalveolar lavage in children with cystic fibrosis: how many lobes should be sampled?. Archives of Disease in Childhood 2011;96(3):215‐7. - PubMed
Hansen 2008
    1. Hansen CR, Pressler T, Hoiby N. Early aggressive eradication therapy for intermittent Pseudomonas aeruginosa airway colonization in cystic fibrosis patients: 15 years experience. Journal of Cystic Fibrosis 2008;7(6):523‐30. - PubMed
Heim 2001
    1. Heim RA, Sugarman EA, Allitto BA. Improved detection of cystic fibrosis mutations in the heterogeneous U.S. population using an expanded, pan‐ethnic mutation panel. Genetics in Medicine: Official Journal of the American College of Medical Genetics 2001;3(3):168‐76. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011a
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011b
    1. Higgins JPT, Altman DG, Sterne JAC on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hilliard 2007
    1. Hilliard TN, Sukhani S, Francis J, Madden N, Rosenthal M, Balfour‐Lynn I, et al. Bronchoscopy following diagnosis with cystic fibrosis. Archives of Disease in Childhood 2007;92(10):898‐9. - PMC - PubMed
Ikeda 1968
    1. Ikeda S, Yani N, Ishikawa S. Flexible bronchofiberscope. Keio Journal of Medicine 1968;17(1):1‐16. - PubMed
Khan 1995
    1. Khan TZ, Wagener JS, Bost T, Martinez J, Accurso FJ, Riches DW. Early pulmonary inflammation in infants with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 1995;151(4):1075‐82. - PubMed
Langton Hewer 2017
    1. Langton Hewer SC, Smyth AR. Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2017, Issue 4. [DOI: 10.1002/14651858.CD004197.pub5] - DOI - PMC - PubMed
Lee 2003
    1. Lee TW, Brownlee KG, Conway SP, Denton M, Littlewood JM. Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients. Journal of Cystic Fibrosis 2003;2(1):29‐34. - PubMed
Li 2005
    1. Li Z, Kosorok MR, Farrell PM, Laxova A, West SE, Green CG, et al. Longitudinal development of mucoid Pseudomonas aeruginosa infection and lung disease progression in children with cystic fibrosis. JAMA 2005;293(5):581‐8. - PubMed
Loeve 2009
    1. Loeve M, Hal PT, Robinson P, Jong PA, Lequin MH, Hop WC, et al. The spectrum of structural abnormalities on CT scans from patients with CF with severe advanced lung disease. Thorax 2009;64(10):876‐82. - PubMed
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses: The PRISMA Statement. Journal of Clinical Epidemiology 2009;62(10):1006‐12. - PubMed
Nixon 2001
    1. Nixon GM, Armstrong DS, Carzino R, Carlin JB, Olinsky A, Robertson CF, et al. Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis. Journal of Pediatrics 2001;138(5):699‐704. - PubMed
Nussbaum 2002
    1. Nussbaum E. Pediatric fiberoptic bronchoscopy: Clinical experience with 2,836 bronchoscopies. Pediatric Critical Care Medicine 2002;3(2):171‐6. - PubMed
Picard 2000
    1. Picard E, Schwartz S, Goldberg S, Glick T, Villa Y, Kerem E. A prospective study of fever and bacteremia after flexible fiberoptic bronchoscopy in children. Chest 2000;117(2):573‐7. - PubMed
Quittner 2009
    1. Quittner AL, Modi AC, Wainwright C, Otto K, Kirihara J, Montgomery AB. Determination of the minimal clinically important difference scores for the Cystic Fibrosis Questionnaire‐Revised respiratory symptom scale in two populations of patients with cystic fibrosis and chronic Pseudomonas aeruginosa airway infection. Chest 2009;135(6):1610‐8. - PMC - PubMed
Rabin 2004
    1. Rabin HR, Butler SM, Wohl ME, Geller DE, Colin AA, Schidlow DV, et al. Pulmonary exacerbations in cystic fibrosis. Pediatric Pulmonology 2004;37(5):400‐6. - PubMed
Rosenfeld 1999
    1. Rosenfeld M, Emerson J, Accurso F, Armstrong D, Castile R, Grimwood K, et al. Diagnostic accuracy of oropharyngeal cultures in infants and young children with cystic fibrosis. Pediatric Pulmonology 1999;28(5):321‐8. - PubMed
Rosenfeld 2001
    1. Rosenfeld M, Emerson J, Williams‐Warren J, Pepe M, Smith A, Montgomery AB, et al. Defining a pulmonary exacerbation in cystic fibrosis. Journal of Pediatrics 2001;139(3):359‐65. - PubMed
Rosenstein 1998
    1. Rosenstein BJ, Cutting GR. The diagnosis of cystic fibrosis: a consensus statement. Cystic Fibrosis Foundation Consensus Panel. Journal of Pediatrics 1998;132(4):589‐95. - PubMed
Sly 2009
    1. Sly PD, Brennan S, Gangell C, Klerk N, Murray C, Mott L, et al. Lung disease at diagnosis in infants with cystic fibrosis detected by newborn screening. American Journal of Respiratory and Critical Care Medicine 2009;180(2):146‐52. - PubMed
Southern 2009
    1. Southern KW, Merelle Marieke ME, Dankert‐Roelse JE, Nagelkerke AD. Newborn screening for cystic fibrosis. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD001402.pub2] - DOI - PMC - PubMed
Stafler 2011
    1. Stafler P, Davies J C, Balfour‐Lynn I M, Rosenthal M, Bush A. Bronchoscopy in cystic fibrosis infants diagnosed by newborn screening. Pediatric Pulmonology 2011;46(7):696‐700. - PubMed
Stuart 2010
    1. Stuart B, Lin J H, Mogayzel P J Jr. Early eradication of Pseudomonas aeruginosa in patients with cystic fibrosis. Paediatric Respiratory Reviews 2010;11(3):177‐84. - PMC - PubMed
UK CF Trust 2004
    1. UK CF Trust. Pseudomonas aeruginosa infection in people with cystic fibrosis. Report of UK CF Trust Infection Control group 2004.
Wood 1978
    1. Wood RE, Fink RJ. Applications of flexible fiberoptic bronchoscopes in infants and children. Chest 1978;73(5 Suppl):737‐40. - PubMed

References to other published versions of this review

Jain 2013
    1. Jain K, Wainwright C, Smyth AR. Bronchoscopy‐guided antimicrobial therapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2013, Issue 12. [DOI: 10.1002/14651858.CD009530.pub2] - DOI - PubMed
Jain 2016
    1. Jain K, Wainwright C, Smyth AR. Bronchoscopy‐guided antimicrobial therapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2016, Issue 1. [DOI: 10.1002/14651858.CD009530.pub3] - DOI - PubMed

MeSH terms

Substances