- •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.
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.
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Published online: February 16, 2023
Accepted: February 10, 2023
Received in revised form: February 2, 2023
Received: December 6, 2022
Publication stageIn Press Corrected Proof
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