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Diagnosis of cystic fibrosis in adulthood and eligibility for novel CFTR modulator therapy
  1. Hannah Farley1,
  2. Sarah Poole2,
  3. Stephen Chapman2,
  4. William Flight2
  1. 1Medical School, Oxford University, Oxford, UK
  2. 2Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  1. Correspondence to Hannah Farley, Medical School, Oxford University, Oxford OX1 2JD, UK; hannah.farley{at}univ.ox.ac.uk

Abstract

Background Cystic fibrosis (CF) is an autosomal recessive condition that primarily manifests as a chronic respiratory disease. CF is usually diagnosed in early childhood or through newborn screening although in a small but important group, diagnosis is not made until adulthood. Highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies are now available for most genetic causes of CF highlighting the importance of identifying people with late presentations of CF.

Aim We aimed to identify the clinical characteristics of people diagnosed with CF in adulthood and their resulting eligibility for novel CFTR modulator therapies.

Design Retrospective single-centre cohort study.

Methods Patients diagnosed with CF at age 18 years or older were identified from a patient database. Paper and electronic medical records were reviewed and clinical, microbiological and radiological data at diagnosis were recorded.

Results Nineteen patients were identified. Median age at diagnosis was 38 years (range: 19–71) and 9 (47%) were female. All patients had a history of chronic respiratory symptoms and 18/19 (94%) had radiological evidence of bronchiectasis. All patients had two pathogenic CFTR mutations identified with 16/19 (84%) compound heterozygotes for the F508del mutation. The majority of patients had a CFTR genotype considered eligible for CFTR modulator therapy (84% and 89% according to European and US licences, respectively).

Conclusions Adult patients with unexplained chronic bronchiectasis should be thoroughly investigated for CF. A low index of suspicion will help to identify adults with undiagnosed CF who are likely to benefit from CFTR modulator therapy.

  • cystic fibrosis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data are summaries of deidentified patient characteristics and is available from the corresponding author for this submission (HF).

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data are summaries of deidentified patient characteristics and is available from the corresponding author for this submission (HF).

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Footnotes

  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors WF planned and supervised the study. HF extracted data and drafted the report. WF, SP and SC edited the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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