Rate of Pulmonary Function Decline in South African Children with Cystic Fibrosis

Background. Pulmonary function tests (PFTs) objectively measure the extent and progression of cystic fibrosis (CF) lung disease. The rate of lung function decline in developing countries has not previously been studied. Aim. To investigate the average annual rates of pulmonary function decline in South African children with CF from 1999 to 2006. Methodology: The medical records and best PFT over 3-monthly intervals of children attending the CF clinic at Red Cross War Memorial Children's Hospital; Cape Town; were retrospectively reviewed and analysed using the mixed model regression method. Results. A total of 1 139 PFT were recorded on 79 patients; with a median (interquartile range) of 14 (6 - 21) PFTs per patient. The mean (standard error) forced expiratory volume in 1 second (FEV1) at age 6 years was estimated at 73.83 (3.34) per cent predicted with an FEV1 decline of 0.23 (0.43)per annum. FEV1 at age 6 was affected by age at CF diagnosis; genotype; and year of birth. Rate of FEV1 decline was significantly affected by Pseudomonas aeruginosa colonisation and genotype. Conclusions. Although FEV1 at age 6 years was low compared with developed countries; the annual rate of FEV1 decline in South African children with CF was minimal; setting the scene for improved survival in this population

Diagnosis and Management of Community-Acquired Pneumonia in Childhood - South African Thoracic Society Guidelines

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence; severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management. Objective: To develop guidelines for the diagnosis; management and prevention of CAP in South African children. Methods: The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence; expert opinion was accepted. After peer review and revision; the position papers were synthesised into an overall guideline which was further reviewed and revised. Recommendations: Recommendations based on epidemiological factors include a diagnostic approach; investigations; supportive therapy; appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided. Validation: These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in aediatrics; paediatric pulmonology; radiology; infectious diseases and microbiology. Published international guidelines have also been consulted