Worsening of the lung function

Question

Hello,
My daughter has been diagnosed to suffer from CF 2 years ago (she was already 17 years old). After the first shock, we have begun to accept the disase. The medical care was very good and the therapy worked well. Her lung function increased concerning the FEV1 value from 80 to 107 in February this year and also her overall health state turned again to be just good. Now the lung function decreased since May to 92; no Pseudomonas, only a Staphylococcus could be detected.
In spite of antibiotics the value did not increase again. Which reasons might be underlying? She is already taking the second time antibiotics within 4 weeks.
Best regards,
C.

Answer

Hello,
you report, that your daughter, who has been diagnosed with CF 2 years ago at the age of 17 years, had at the beginning an FEV1 value of 80% and that this value increased to 107% in February this year. Now you are worrying, as the value decreased to 92% in May and stayed since then on this level in spite of two antibiotic therapy courses. Only Staphylococcus aureus had been found in your daughter's swab.
In general it can be said about those values, that also an FEV1 value of 92% has to be judged as normal. It has to be questioned, if the value of 107% was a single measurement and has therefore to be judged as a positive discordant value or if this very good value could be measured several times on different days.
Furthermore it has to be clarified, if any drug therapy had been changed before the measurement in May, that could probably had a positive influence on the lung function. In here, also contraceptive drugs have to be discussed.
As the value of 107% has been measured in February, therefore at the end of the winter, it has to be considered, if a decrease of the value could be in correlation to an allergic reaction. Here a reaction to e.g. pollen of blooming trees or grases come into question. Of course Staph. aureus or viruses could be the reason for the change of the results in the frame of a slight infection.
Furthermore it has to be checked, if it came to a thickening of the bronchial secretions in the frame of the hot summer time due to a relative lack of fluid. Here, the electrolytes in the blood should be measured and it should be checked if the sugar meatbolism is normal.
I hope to have helped you with these remarks and wish you and your daughter all the best.
Yours sincerely,
Dr. H.-G. Posselt

29.09.2014