Highlights
- •Many researchers use ‘before and after’ approaches to study lung function recovery around a pulmonary exacerbation.
- •This method lacks comparators and ascribes recovery failure to PEx.
- •Comparisons and simulations show ‘recovery’ is prone to artifact and poorly define PEx contributions to disease progression.
Abstract
CF registry pulmonary exacerbation (PEx) analyses have employed “before and after”
spirometry recovery, where the best percent predicted forced expiratory volume in
1 s (ppFEV1) prior to PEx (“baseline”) is compared to the best ppFEV1 <3 months post-PEx. This methodology lacks comparators and ascribes recovery failure
to PEx.
Herein, we describe 2014 CF Foundation Patient Registry PEx analyses including a comparator:
recovery around nonPEx events, birthdays. 49.6% of 7357 individuals with PEx achieved
baseline ppFEV1 recovery while 36.6% of 14,141 achieved baseline recovery after birthdays; individuals
with both PEx and birthdays were more likely to recover baseline after PEx than after
birthdays (47% versus 34%); mean ppFEV1 declines were 0.3 (SD=9.3) and 3.1 (9.3), respectively. Post-event measure number
had more effect on baseline recovery than did real ppFEV1 loss in simulations, suggesting that PEx recovery analyses lacking comparators are
prone to artifact and poorly describe PEx contributions to disease progression.
Keywords
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Article info
Publication history
Published online: February 16, 2023
Accepted:
February 10,
2023
Received in revised form:
February 2,
2023
Received:
December 6,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
