Effect of Bronchoalveolar Lavage-Directed Therapy on Pseudomonas aeruginosa Infection and Structural Lung Injury in Children With Cystic Fibrosis A Randomized Trial
Claire E Wainwright, Suzanna Vidmar, David S Armstrong, Catherine A Byrnes, John B Carlin, Joyce Cheney, Peter J Cooper, Keith Grimwood, Marj Moodie, Colin F Robertson, Harm A Tiddens
JAMA: Journal of the American Medical Association | AMER MEDICAL ASSOC | Published : 2011
CONTEXT: 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 tria..View full abstract
Awarded by National Health and Medical Research Council
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Wainwright reported receiving travel grants from North American Cystic Fibrosis Foundation and from the European Cystic Fibrosis Society, funding from Novartis to cover an extra night at European CF Conference 2010, travel and accommodation expenses from the UK CF Trust, and travel and accommodation expenses from the University of Miami; serving as a board member for Novartis Pharma; serving as a consultant for Vertex Pharmaceuticals Inc, Gilead Sciences Inc, and Inspire Pharmaceuticals Inc; receiving grants or grants pending from GlaxoSmithKline, Boehringer-Ingelheim, Vertex Pharmaceuticals Inc, and Insmed Inc; and receiving payment for lectures (including speakers bureau) from Novartis Pharma. Dr Byrnes reported receiving grant support from the New Zealand Health Research Council and the Faculty Research Development Fund (University of Auckland); and receiving travel support from the National Health and Medical Research Council (Australia). Dr Carlin reported receiving review activities fees from the Royal Children's Hospital Queensland. Dr Cooper reported serving as a board member for Pharmaxis Pty Ltd; and receiving grants or grants pending from Vertex Pharmaceuticals Inc, Inspire Pharmaceuticals Inc, and Gilead Sciences Inc. Dr Robertson reported serving as a consultant on advisory boards for Glaxo Seretide and Singulair; and receiving grants or grants pending from the National Health and Medical Research Council. Dr Tiddens reported serving as a consultant for Gilead Sciences Inc, Vertex Pharmaceuticals Inc, and Inspire Pharmaceuticals Inc; receiving grants or grants pending from Gilead Sciences Inc; and receiving payment for lectures from Roche. No other authors reported disclosures.This study was supported by the National Health and Medical Research Council (grants 9937868 and 351541) and the Royal Children's Hospital Foundation, Australia. The tobramycin inhalation solution and delivery system used throughout the study was supplied by Pathogenesis Corporation, Chiron Corporation, and Novartis Pharmaceuticals Inc.The National Health and Medical Research Council, the Royal Children's Hospital Foundation, Pathogenesis Corporation, Chiron Corporation, and Novartis Pharmaceuticals Inc had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.