Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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SESSION THREE ONE
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
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SESSION
SESSION THREE ONE
Cystic Fibrosis
3.23
Distinguishable clinical clusters during acute pulmonary
exacerbations of Cystic Fibrosis
Introduction
Acute pulmonary exacerbations represent the most
frequent complication in the evolution of Cystic
Fibrosis (CF) pulmonary disease with at least 42% of
CF patients experiencing one or more exacerbations
during a six month period. Although concurrent
symptoms are frequently reported in clinical practice,
the presence of groupings of related symptoms during
acute pulmonary exacerbations of CF has never
previously been explored. This study investigated
whether there exist subtypes of symptom patterns
among adult CF patients presenting with acute
pulmonary exacerbations of their disease.
Methods
Fifty-seven CF patients (23 male, 34 female)
median age 24.9 years (range 18 to 46), admitted
consecutively to hospital for management of an
acute pulmonary exacerbation, were enrolled. Each
patient was asked to complete a standardised
questionnaire, consisted of twenty-one symptoms,
to assess symptomatology at exacerbation
presentation. Patients were asked to grade the
intensity of each symptom as new in onset,
increased from baseline, decreased from baseline, or
not present.
Results
Using hierarchical cluster analysis, five clinically
distinct symptom clusters were identified in the
studied population, with the majority of patients
presenting in the cough-predominant cluster.
Conclusion
These findings have important clinical implications
on patient assessment and management. Clinical
interventions tailored to the predominant cluster
subtype may result in improved treatment outcome.
Longitudinal studies are required to determine
whether these proposed clusters remain stable and
independent over time or merge into a single group
over the course of illness.
DF Waterhouse,
R Barry, CG Gallagher
Dept of Respiratory
Medicine and the
National Referral
centre for Adult Cystic
Fibrosis, St Vincent’s
University Hospital,
Dublin
Supported by the
Cystic Fibrosis
Association of Ireland
and the Health
Research Board
3.25
The introduction of once daily tobramycin dosing at the
national referral centre for adult Cystic Fibrosis in
St Vincent’s University Hospital, Dublin
Introduction
Due to its good activity against Pseudomonas
aeruginosa, tobramycin is one of the most
commonly used drugs to treat an infective
exacerbation of Cystic Fibrosis. Following the
publication of the TOPIC study it was decided to
introduce once daily dosing of tobramycin at the
National Referral Centre for Adult Cystic Fibrosis
(NRCACF) in St. Vincent’s University Hospital.
Method
The first 43 patients to receive tobramycin oncedaily
were studied intensively. Among the most
important parameters studied were pre- and postdoes
tobramycin levels, serum creatinine levels and
the single daily dose administered, expressed per
kilogram bodyweight.
Results
The results of the study showed that 79.1% of
patients received a tobramycin course in which the
recorded levels were within the therapeutic range.
This compares to just 50% of patients reaching
therapeutic levels in a previous study carried
out in St. Vincent’s University Hospital in 2002,
which involved three-times daily administration
of tobramycin. Two patients in the current study
showed tobramycin levels in the toxic range, while
a further four patients exhibited increases in serum
creatinine suggestive of renal toxicity. There were no
reports of ototoxicity during the study period.
Conclusions
The once-daily administration protocols compiled
for the changeover from three-times daily to oncedaily
tobramycin dosing ensured that the changeover
occurred smoothly and with no disruption for
patients. Switching to once daily tobramycin ensured
that a higher proportion of patients achieved serum
levels within the therapeutic range.
C Muldowney, C Keane
Pharmacy Dept,
St Vincent’s University
Hospital, Dublin
3.24
Reproducibility of peripheral muscle strength testing
in adult Cystic Fibrosis patient
Introduction
Accurate and quantitative muscle strength testing
plays an important role in monitoring disease
progression and assessing patient response to
treatment intervention. The aim of this study was to
investigate the test-retest repeatability of strength
testing of the quadriceps muscle using a fixed
hand held digital dynamometer (FHDD) versus one
repetition maximum (1RM). The reproducibility of
these indices has not previously been established
Methods
Twenty one CF patients (14 male, 7 female) median
age 27 (range 17-53 years) with clinically stable
disease were enrolled in the study. Quadriceps
strength was measured in all participants, using
both FHDD and 1RM, each week for a period of four
consecutive weeks. Both patient and examiner were
blinded to the previous week’s results at the time
of strength testing. Furthermore, participants were
clinically reviewed each week to ensure continued
disease stability.
Results
Using the Bland and Altman method, results
achieved on week one and week four display
a learning curve and muscle fatigue, despite
standardised rest period, when using 1RM.
Additionally, using paired t-testing to compare
results achieved, there was significant stability in
results achieved with FHDD.
Conclusion
This research shows that the 1RM involves a skill
factor and subsequent tests yield better results.
Furthermore, no learning effect was observed with
FHDD and this has been shown to be a highly
reliable means of muscle strength assessment.
Thus, in conclusion, FHDD is the most sensitive and
least variable method of peripheral muscle strength
assessment.
CM Reilly, 1
DF Waterhouse, 2
CG Gallagher 2
1. Dept of
Physiotherapy and
2. Dept of Respiratory
Medicine, National
Referral Centre
for Adult Cystic
Fibrosis, St Vincent’s
University Hospital,
Dublin
Supported by the
Cystic Fibrosis
Association of Ireland
and the Health
Research Board
3.26
Emergence of high grade tobramycin resistance in
P. aeruginosa isolates in the sputum of children on
bedulised tobramycin solution for inhalation
Background
Chronic enbronchial infection with Pseudomonas
aeruginosa (PA) is associated with a deterioration
in lung function in patients with Cystic Fibrosis.
Preservative-free tobramycin for inhalation (TOBI®)
has been recently developed as maintenance
anti-pseudomonal antibiotic. Randomised trials
of alternate month use have shown beneficial
effects on pulmonary function and weight gain,
and reduction of bacterial load. Clinically significant
high grade resistance has not been described. We
previously reported the beneficial clinical effects
of TOBI in our CF patient population. Like other
investigators, we noted an increase in low grade
(10mcg/ml) resistance to tobramycin. However
high grade (200mcg/ml) resistance of P Aeruginosa
isolates was not observed at that time.
Aims
The purpose of this study was to evaluate PA isolates
for the presence of high grade TOBI resistance and
if confirmed, to determine what, if any clinical
parameters could be identified as risk factors for its
development.
Method
A retrospective chart review was conducted on all
children with a persistent growth of PA who were
receiving TOBI. The following data was recorded
subsequent to starting on treatment: Anthropometric
indices, genotype, antibiotic resistance of PA
strains, number of IV antibiotic courses, use of IV
aminoglycosides and use of IV tobramycin.
Results
Twenty six patients with PA infection were being
treated with TOBI. The mean duration of treatment
at the time of study was 33 months. Low grade
resistance developed in 16 patients, 8 of whom went
on to develop high grade resistance. Mean duration
to development of consistent low grade resistance
was 15.6 months and to high grade resistance was
P McNally, G Leen,
M Doyle, P Murphy,
P Greally
Dept of Cystic Fibrosis
National Children’s
Hospital, Talaght,
Dublin
34 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3
IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 35