Abstract
Cystic fibrosis (CF) is an inherited disease affecting multiple systems, which can result in progressive lung disease, pancreatic insufficiency, malnutrition, distal intestinal obstruction syndrome, liver dysfunction, and other disorders. In 1938, all children with cystic fibrosis died in infancy, but today the average life expectancy is between 28 and 47.7 years. To optimize short- and long-term outcomes, early diagnosis and treatment by multidisciplinary teams are paramount. Traditional supportive therapies are still crucial in preventing or treating damage to every organ system, and also lately, the introduction of highly effective modulator therapies targeting specific CF transmembrane conductance regulator protein defects resulting from individual genetic mutations has considerably improved the life span and quality and prognosis of CF patients. We hope that this chapter will provide healthcare professionals with an up-to-date assessment of the CF’s pathophysiology, diagnosis, clinical features, and evidence-based new treatments of CF.
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References
Stoltz DA, Meyerholz DK, Welsh MJ. Origins of cystic fibrosis lung disease. New Engl J Med. 2015;372:351–62.
Farrell PM. The prevalence of cystic fibrosis mutations in European Union. J Cyst Fibros. 2008;7:179–96.
Brennan ML, Schrijver I. Cystic fibrosis: a review of associated phenotypes, use of molecular diagnostic approaches, genetic characteristics, progress, and dilemmas. J Mol Diagn. 2016;18:3–14.
Andersen DH. Cystic fibrosis of the pancreas and its relation to celiac disease. Am J Dis Child. 1938;56:344–99.
Hurley MN, McKeever TM, Prayle AP, et al. Rate of improvement of CF life expectancy exceeds that of general population-observational death registration study. J Cyst Fibros. 2014;13:410–5.
https://www.cysticfibrosis.ca/uploads/RegistryReport2018/2018RegistryAnnualDataReport.pdf
Riordan JR, Rommens JM, Kerem BS, et al. Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA. Science. 1989;245:1066–73.
ECFS Patient registry annual report. 2018. https://www.ecfs.eu/projects/ecfs-patient-registry/annual-reports
Sosnay PR, Siklosi KR, Van Goor F, et al. Defining the disease liability of variants in the cystic fibrosis transmembrane conductance regulator gene. Nat Genet. 2013;45:1160–7.
Veit G, Avramescu RG, Chiang AN, et al. From CFTR biology toward combinatorial pharmacotherapy: expanded classification of cystic fibrosis mutations. Mol Biol Cell. 2016;27:424–33.
De Boeck K. Cystic fibrosis in the year 2020: a disease with a new face. Acta Paediatr. 2020;109:893–9.
Zieleneski J. Genotype and phenotype in cystic fibrosis. Respiration. 2000;67:117–33.
Cant N, Pollock N, Ford RC. CFTR structure and cystic fibrosis. Int J Biochem Cell Biol. 2014;52:15–25.
Cutting GR. Modifier genes in mendelian disorders: the example of cystic fibrosis. Ann N Y Acad Sci. 2010;1214:57–9.
Baucher RC. Airway surface dehydration in cystic fibrosis: pathogenesis and therapy. Annu Rev Med. 2007;58:157–70.
Cohen-Cymberknoh M, Kerem E, Ferkol T, et al. Airway inflammation in cystic fibrosis: molecular mechanisms and clinical implications. Thorax. 2013;68:1157–62.
Cohn JA, Noone PG, Jowell PS. Idiopathic pancreatitis related to CFTR: complex inheritance and identification of a modifier gene. J Investig Med. 2002;50:247S–55S.
Wilschanski M, Novak I. The cystic fibrosis of exocrine pancreas. Cold Spring Harb Perspect Med. 2013;3:1–17.
Chamnan P, Shine BS, Haworth CS, et al. Diabetes as a determinant of mortality in cystic fibrosis. Diabetes Care. 2010;33:311–6.
Kinnman N, Lindblad A, Housset C, et al. Expression of cystic fibrosis transmembrane conductance regulator in liver tissue from patients with cystic fibrosis. Hepatology. 2000;32:324–40.
Meyerholz DK, Stoltz DA, Pezzulo AA, et al. Pathology of gastrointestinal organs in porcine model of cystic fibrosis. Am J Pathol. 2010;176:1377–89.
Gibson LE, Cooke RE. A test for concentration of electrolytes in sweat in cystic fibrosis of the pancreas utilizing pilocarpine by iontophoresis. Pediatrics. 1959;23:545–9.
De Souza DAS, Faucz FR, Pereira-Ferrari L. Congenital bilateral absence of the vas deferens as an atypical form of cystic fibrosis: reproductive implications and genetic counseling. Andrology. 2018;6:127–35.
Foweraker J. Recent advances in the microbiology of respiratory tract infection in cystic fibrosis. Br Med Bull. 2009;89:93–110.
Elston C, Geddes D. Inflammation in cystic fibrosis – when and why? Friend or foe? Semin Respir Crit Care Med. 2007;28:286–94.
Foweraker J. Recent advances in the microbiology of respiratory tract infection in cystic fibrosis. Br Med Bull. 2009;889:93–110.
Richards CJ, Olivier KN. Nontuberculous mycobacteria in cystic fibrosis. Semin Respir Crit Care Med. 2019;40:737–50.
Stevens DA, Kurup VP, Crameri R, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis-state of art: Cystic Fibrosis Foundation consensus conference. Clin Infect Dis. 2003;37:S225–64.
Wat D, Gelder C, Hibbitts S, et al. The role of respiratory viruses in cystic fibrosis. J Cyst Fibros. 2008;7:320–8.
Hızal M, Yalçın E, Alp A, et al. Respiratory viruses: what is their role in acute exacerbation in children with cystic fibrosis. Pediatr Pulmonol. 2020;55:1646–52.
Flume PA. Pulmonary complications of cystic fibrosis. Respir Care. 2009;54:618–25.
Brody AS, Molina PL, Klein JS, et al. High-resolution computed tomography of the chest in children with cystic fibrosis: support for use as an outcome surrogate. Pediatr Radiol. 1999;29:731–5.
Wielputz MO, Puderbach M, Kopp-Schneider A, et al. Magnetic resonance imaging detects changes in structure and perfusion, and response to therapy in early cystic fibrosis lung disease. Am J Respir Crit Care Med. 2014;189:956–65.
Pillarisetti N, Williamson E, Linnane B, et al. Infection, inflammation, and lung function decline in infants with cystic fibrosis. Am J Respir Crit Care Med. 2011;184:75–81.
Aurora P, Bush A, Gustafsson P, et al. Multiple-breath washout as a marker of lung disease in preschool children with cystic fibrosis. Am J Respir Crit Care Med. 2005;171:249–56.
Kang SH, Dalcin PT, Piltcher OB, et al. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis update on diagnosis and treatment. Brazil J Pneumol. 2015;41:65–76.
Fundakowski C, Ojo R, Younis R. Rhinosinusitis in pediatric patients with cystic fibrosis. Curr Pediatr Rev. 2014;10:198–201.
Handelsman JA, Nasr SZ, Pitts C, et al. Prevalence of hearing and vestibular loss in cystic fibrosis patients exposed to aminoglycosides. Pediatr Pulmonol. 2017;52:1157–62.
Ooi CY, Durie PR. Cystic fibrosis from the gastroenterologist’s perspective. Nat Rev. 2016;13:175–85.
Kelly T, Buxbaum J. Gastrointestinal manifestations of cystic fibrosis. Dig Dis Sci. 2015;60:1903–13.
Flass T, Narkewicz MR. Cirrhosis and other liver disease in cystic fibrosis. J Cyst Fibros. 2013;12:116–24.
Dupuis A, Keenan K, Ooi CY, et al. Prevalence of meconium ileus marks the severity of mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Genet Med. 2016;18:333–40.
Colombo C, Ellemunter H, Houwen R, et al. Guidelines for the diagnosis and management of distal intestinal obstruction syndrome in cystic fibrosis patients. J Cyst Fibros. 2011;10:S24–8.
Demeyer S, De Boeck K, Witters P, et al. Beyond pancreatic insufficiency and liver disease in cystic fibrosis. Eur J Pediatr. 2016;175:881–94.
Maisonneuve P, FitzSimmons SC, Neglia JP, et al. Cancer risk in non-transplanted and transplanted cystic fibrosis patients: a 10-year study. J Natl Cancer Inst. 2003;95:381–7.
Milla CE, Warwick WJ, Moran A. Trends in pulmonary function in patients with cystic fibrosis correlate with the degree of glucose intolerance at baseline. Am J Respir Crit Care Med. 2000;162:891–5.
O’Riordan SM, Robinson PD, Donagdue KC, et al. Management of cystic-fibrosis related diabetes. Pediatr Diabetes. 2008;9:338–44.
Aswani N, Taylor CJ, McGaw J, et al. Pubertal growth and development in cystic fibrosis: a retrospective review. Acta Paediatr. 2003;92:1029–32.
Marquette M, Hawort CS. Bone health and disease in cystic fibrosis. Paediatr Respir Rev. 2016;20S:2–5.
McCallum TJ, Milunsky JM, Cunningham DL, et al. Fertility in men with cystic fibrosis: an update on current surgical practices and outcomes. Chest. 2000;118:1059–62.
Hughan KS, Daley T, Socorro Rayas M, et al. Female reproductive health in cystic fibrosis. J Cyst Fibros. 2019;18:S95–S104.
Ozcelik U, Gocmen A, Kiper N, et al. Sodium chloride deficiency in cystic fibrosis patients. Eur J Pediatr. 1994;153:829–31.
SismanlarEyuboglu T, Dogru D, Cakir E, et al. Clinical features and accompanying findings of Pseudo Bartter syndrome in cystic fibrosis. Pediatr Pulmonol. 2020;55:2011–6.
Quittner AL, Abbott J, Georgiopoulos AM, et al. International Committee on Mental Health in Cystic Fibrosis: Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety. Thorax. 2016;71:26–34.
Cohen-Cymberknoh M, Tanny T, Breuer O, et al. Attention deficit hyperreactivity disorder symptoms in patients with cystic fibrosis. J Cyst Fibros. 2018;17:281–5.
Abbott J, Hart A, Havermans T, et al. Measuring quality of life in clinical trials in cystic fibrosis. J Cyst Fibros. 2011;Supp l2:582–5.
Fitzgerald C, George S, Somerville R, et al. Caregiver burden of parents of young children with cystic fibrosis. J Cyst Fibros. 2018;17:125–31.
Farrell PM, Rosenstein BJ, White TB, et al. Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report. J Pediatr. 2008;153:S4–S14.
Farrell PM, White TB, Ren CL, et al. Diagnosis of cystic fibrosis: consensus guidelines from the Cystic Fibrosis Foundation. J Pediatr. 2017;181S:S4–15.
De Boeck K, Vermeulen F, Deupont L. The diagnosis of cystic fibrosis. Presse Med. 2017;46:e97–e108.
Wilson DC, Ellis L, Zielenski J, et al. Uncertainty in the diagnosis of cystic fibrosis: possible role of in vivo nasal potential difference measurements. J Pediatr. 1998;132:596–9.
Southern KW, Noone PG, Bosworth DG, et al. A modified technique for measurement of nasal potential difference in infants. J Pediatr. 2001;139:353–8.
Standaert TA, Boitano L, Emerson J, et al. Standardized procedure for measurement of nasal potential difference: an out-come measure in multicenter cystic fibrosis clinical trials. Pediatr Pulmonol. 2004;37:385–92.
De Boeck K, Derichs N, Fajac I, et al. New clinical diagnostic procedures for cystic fibrosis in Europe. J Cyst Fibros. 2011;Suppl 2:S53–66.
Brewington J, Clancy JP. Diagnostic testing in cystic fibrosis. Clin Chest Med. 2016;37:31–46.
Farrell PM, Kosorok MR, Rock MJ, et al. Early diagnosis of cystic fibrosis through neonatal screening prevents severe malnutrition and improves long-term growth. Pediatrics. 2001;107:1–13.
Collins MS, Abbott MA, Wakefield DB, et al. Improved pulmonary and growth outcomes in cystic fibrosis by newborn screening. Pediatr Pulmonol. 2008;43:648–55.
Koscik RL, Farrell PM, Kosorok MR, et al. Cognitive function of children with cystic fibrosis: deleterious effect of early malnutrition. Pediatrics. 2004;113:1549–58.
Comeau AM, Accurso FJ, White TB, et al. Guidelines for implementation of cystic fibrosis newborn screening programs: cystic fibrosis foundation workshop report. Pediatrics. 2007;119:e495–517.
Sontag MK, Lee R, Wright D, et al. Improving the sensitivity and positive predictive value in acystic fibrosis newborn screening program using a repeat immunoreactive trypsinogen and genetic analysis. J Pediatr. 2016;175:150–8.
Comeau AM, Parad RB, Dorkin HL, et al. Population-based newborn screening for genetic disorders when multiple mutation DNA testing is incorporated: a cystic fibrosis newborn screening model demonstrating increased sensitivity but more carrier detections. Pediatrics. 2004;113:1573–81.
Castellani C, Southern KW, Brownlee K, et al. European best practice guidelines for cysticfibrosis neonatal screening. J Cyst Fibros. 2009;8:153–73.
Sommerburg O, Krulisova V, Hammermann J, et al. Comparison of different IRT-PAP protocols to screen newborns for cystic fibrosis in three central European populations. J Cyst Fibros. 2014;13:15–25.
Farrell PM, White TB, Howenstine MS, et al. Diagnosis of cystic fibrosis in screened populations. J Pediatr. 2016;181S:S33–44.
De Boeck K, Wilschanski M, Castellani C, et al. Cystic fibrosis: terminology and diagnostic algorithm. Thorax. 2006;61:627–35.
Bombieri C, Claustres M, De Boeck K, et al. Recommendations for the classification of the diseases as CFTR-related disorders. J Cyst Fibros. 2011;Suppl 2:S86–S102.
Sermet-Gaudlus I, Brouard J, Audrezet MP, et al. Guidelines for the clinical management and follow-up of infants with inconclusive cystic fibrosis diagnosis through newborn screening. Arch Pediatr. 2017;24:e1–e14.
Edmondson C, Davies JC. Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical implications. Ther Adv Chronic Dis. 2016;7(3):170–83.
Elborn JS. Cystic fibrosis. Lancet. 2016;388:2519–31.
Clancy JP, Cotton CU, Donaldson SH, et al. CFTR modulator theraty**: current status, gaps and future directions. J Cyst Fibros. 2019;18(1):22–34.
Ramsey BW, Downey GP, Goss CH. Update in cystic fibrosis 2018. Am J Respir Crit Care Med. 2019;199:1188–94.
Strug LJ, Stephenson AL, Panjwani N, et al. Recent advances in develo** therapeutics for cystic fibrosis. Hum Mol Genet. 2018;27:173–86.
Skov M, Hansen CR, Pressler T. Cystic fibrosis -an example of personalized and precision medicine. APMIS. 2019;127:352–60.
NICE guideline (2017) Cystic fibrosis: diagnosis and management. www.nice.org.uk/guidance/ng78. Accessed 25 October 2017.
Castellani C, Duff A, Bell SC, et al. ECFS best practice guidelines: the 2018 revision. J CysticFibros. 2018;17:153–78.
Michelson P, Faro A, Ferkol T. Kendig’s disorders of the respiratory tracts in children. In: Wilmott RW, Deterding R, Li A, Ratjen F, Sly P, Zar HJ, Bush A, editors. Pulmonary disease in cystic fibrosis. 9th ed. Philadelphia: Elsevier; 2019. p. 777–87.
Lynch JP, Sayah DM, Belperio JA. Lung transplantation for cystic fibrosis: results, indications, complications, and controversies. Semin Respir Crit Care Med. 2015;36:299–320.
Snell G, Reed A, Stern M, et al. The evolution of lung transplantation for cystic fibrosis: a 2017 update. J Cyst Fibros. 2017;16:553–64.
Solomon M, Bozaic M, Mascarenhas MR. Nutritional issues in cystic fibrosis. Clin Chest Med. 2016;37:97–107.
Shoff SM, Tluczek A, Laxova A, et al. Nutritional status is associated with health-related quality of life in children with cystic fibrosis aged 9-19 years. J Cyst Fibros. 2013;12:1–13.
Turck D, Braegger CP, Colombo C, et al. ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutri. 2016;35:557–77.
Moran A, Pillay K, Becker DJ, et al. ISPAD clinical practice consensus guidelines 2014 compendium: Management of cystic fibrosis-related diabetes in children and adolescents. Pediatr Diabetes. 2014;15:65–76.
Moran A, Brunzell C, Cohen RC, et al. Clinical care guidelines for cystic fibrosis-related diabetes: a position statement of the American Diabetes Association and a clinical practice guideline of the cystic fibrosis foundation, endorsed by the pediatric endocrinology society. Diabetes Care. 2010;33:2697–708.
Stern RC, Boat TF, Wood RE, et al. Treatment and prognosis of nasal polyps in cystic fibrosis. Am J Dis Child. 1982;136:1067–70.
Hughes A, Adil EA. What is the role of endoscopic sinus surgery in adult patients with cystic fibrosis? Laryngoscope. 2015;125:2018–20.
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Yalçın, E., Özçelik, U. (2023). Cystic Fibrosis. In: Cingi, C., Yorgancıoğlu, A., Bayar Muluk, N., Cruz, A.A. (eds) Airway diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-22483-6_109-1
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