Spirometer-triggered high-resolution computed tomography and pulmonary function measurements during an acute exacerbation in patients with cystic fibrosis

Objective: To evaluate a high-resolution computed tomography (HRCT) scoring system, clinical parameters, and pulmonary function measurements in patien ts with cystic fibrosis (CF) before and after therapy for a pulmonary exace rbation. Study design: Patients (n = 17) were evaluated by spirometer-triggered HRCT imaging, clinical parameters, and pulmonary function tests (PFTs) before a nd after treatment. HRCT scans were reviewed by 3 radiologists using a modi fied Bhalla scoring system. Results: Bronchiectasis, bronchial wall thickening and air trapping were id entified in all subjects on initial evaluation. The initial total HRCT scor e correlated significantly with the Brasfield score (r = -.91, P < .001) an d several PFT measures. After treatment, there were improvements in the acu te change clinical score (ACCS) (P < .001), most pulmonary function measure ments, and total HRCT score (P < .05). Bronthiectasis, bronchial wall thick ening, and air trapping did nut significantly change. Mucus plugging subcom ponent HRCT score, slow vital capacity (SVC), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) (percent predicted) and rev ersible and total HRCT scores were most sensitive to change by effect size analysis. Conclusions: Improvements occurred with treatment in total and reversible H RCT scores, PFTs, and ACCS, Total and reversible HRCT scores and percent pr edicted SVC, FEV1, and FVC were the most sensitive to change. The greatest change was seen in the mucus plugging subcomponent HRCT score.