Early childhood risk factors for decreased FEV1 at age six to seven years in young children with cystic fibrosis

Don B. Sanders, Julia Emerson, Clement L. Ren, Michael S. Schechter, Ronald L. Gibson, Wayne Morgan, Margaret Rosenfeld

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Rationale: There are limited objective measures of the severity of lung disease before children are able to routinely perform spirometry, generally at age 6 years. Identifying risk factors for reduced lung function at age 6 provides opportunities to intervene and slow the progression of cystic fibrosis (CF) lung disease. Objectives: To evaluate early childhood predictors of lung function at age 6-7 in a large U.S. CF cohort in the current era of widespread early eradication therapy for Pseudomonas aeruginosa (P. aeruginosa). Methods: Participants were children with CF enrolled before age 4 in the Early Pseudomonas Infection Control (EPIC) Observational Study, a multicenter, longitudinal study that enrolled P. aeruginosa-negative children not exceeding 12 years of age. Linear regression was used to estimate the association between potential early childhood risk factors and the best FEV1%predicted at age 6-7 years. Measurements and Main Results: Four hundred and eightyfour children (of 1,797 enrolled in the EPIC Observational Study) met the eligibility criteria for this analysis. Mean (SD) age at enrollment was 2.0 (1.3) years. In a multivariable model adjusted for age at enrollment, the following risk factorswere significantly associatedwith lower mean (95% confidence interval) FEV1% predicted at age 6-7: weight percentile less than 10% during the year of enrollment (-5.3 [-9.1, -1.5]), P. aeruginosa positive during the year of enrollment (-2.8 [-5.7, 0.0]), crackles or wheeze during the year of enrollment (-5.7 [-9.4, -1.9]), mother's education of high school or less (-4.2 [-7.3, -1.2]), and mother smoked during pregnancy (-4.4 [-8.8, 0.1]). Conclusions: In this large U.S. cohort, we identified several early childhood risk factors for lower FEV1 at age 6-7 years, most of which are modifiable.

Original languageEnglish (US)
Pages (from-to)1170-1176
Number of pages7
JournalAnnals of the American Thoracic Society
Issue number8
StatePublished - Aug 1 2015


  • Cystic fibrosis
  • Lung function
  • Microbiology
  • Tobacco smoke pollution

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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