Original article
Sputum changes associated with therapy for endobronchial exacerbation in cystic fibrosis*

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We sought to define objective indicators of the resolution of Pseudomonas aeruginosa endobronchial infection in patients with cystic fibrosis. We prospectively studied 75 patients admitted for treatment of a pulmonary exacerbation and quantitated sputum bacterial density, DNA content, and the concentration of albumin and total protein in sputum, and compared these values with clinical evaluation. Eleven of the 75 patients had systemic signs, fever, and leukocytosis, which we arbitrarily defined as due to endobronchial infection. At the end of hospitalization, these 11 patients were afebrile, had peripheral leukocyte counts in the normal range, and were judged improved. Sputum P. aeruginosa density, DNA content, and total protein content on admission were similar in the two illness groups. Hospitalization and parenteral antibiotic administration for an average of 14.6 days were associated with improved pulmonary function in all 75 subjects (P values for forced vital capacity, forced expiratory volume at 1 second, and peak expiratory flow rate were all <0.001). With improvement, there was a decrease in sputum P. aeruginosa density (mean of both groups decreased from 107.80 CFU/g on admission to 105.96 CFU/g; P<0.001), and a decreased DNA concentration (overall mean 4.73±4.75 on admission to 2.76±2.49 mg/g; P<0.002). The decrease in sputum total protein concentration for both groups was not significant (overall mean 60.5±48.4 to 43.9±38.2 mg/g; P=0.06). Sputum albumin concentrations did not change in either group. We concluded that in cystic fibrosis subjects with a pulmonary exacerbation, bacterial density, sputum DNA and protein content decrease with hospitalization and parenteral antiblotic therapy. At the end of treatment, these indices of sputum infection and infiammation correlated with improved pulmonary function and clinical improvement. These changes are independent of the presence or absence of fever on admission.

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Supported in part by grants from Miles Pharmaceuticals and The Cystic Fibrosis Foundation, and grant GM 26550 from the National Institutes of Health.