{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:47:18Z","timestamp":1792432038171,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>The introduction of elexacaftor\/tezacaftor\/ivacaftor (ETI), a highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy, to younger ages and the COVID\u201019 pandemic have significantly reduced pulmonary exacerbations requiring hospitalization among children with CF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess demographic and clinical characteristics of children and young adults with CF hospitalized for pulmonary exacerbations before and after pediatric ETI approval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review was conducted at five United States CF Foundation\u2010accredited care centers. Hospitalization data from children and young adults with CF in 2018 and 2022 were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hospitalizations decreased from 471 cases (241 individuals) in 2018 to 163 cases (110 individuals) in 2022. The racial distribution shifted, with more hospitalized patients identifying as people of color in 2022 (28% vs. 14%; <jats:italic>p<\/jats:italic>\u2009=\u20090.018). A greater proportion of hospitalized children in 2022 had two non\u2010F508del mutations compared with children hospitalized in 2018 (38% vs. 19%) and were less likely to be infected with methicillin\u2010resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA). Comparing 2022\u22122018, children on CFTR modulator therapy, including ETI (76%), showed reduced infections with <jats:italic>Pseudomonas aeruginosa<\/jats:italic> and <jats:italic>Achromobacter xylosoxidans<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The decline in hospitalizations for pulmonary exacerbations likely reflects the benefits of ETI therapy, as a higher proportion of children and young adults hospitalized in 2022 had two non\u2010F508del mutations and were not eligible for ETI. A greater percentage of those hospitalized in 2022 identified as belonging to minority racial groups, highlighting ongoing health disparities in the ETI era. Additionally, there were notable changes in the microbiological characteristics between 2018 and 2022.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.71019","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T13:52:50Z","timestamp":1741701170000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Changing Epidemiology of Pediatric Pulmonary Exacerbations in Cystic Fibrosis"],"prefix":"10.1002","volume":"60","author":[{"given":"Yaron","family":"Fireizen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Rady Children's Hospital University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamoud","family":"Ahmed","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Vigers","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital Colorado University of Colorado Anschutz Medical Campus Aurora Colorado USA"},{"name":"Department of Biostatistics and Informatics, Colorado School of Public Health University of Colorado Anschutz Medical Campus Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2104-8436","authenticated-orcid":false,"given":"Kathryn","family":"Akong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rady Children's Hospital University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rady Children's Hospital University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5117-0080","authenticated-orcid":false,"given":"Andrea","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's National Hospital George Washington University School of Medicine and Health Sciences Washington District of Columbia USA"},{"name":"Center for Genetic Medicine Research, Children's National Research Institute Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Fanous","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's National Hospital George Washington University School of Medicine and Health Sciences Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4400-4885","authenticated-orcid":false,"given":"Anastassios","family":"Koumbourlis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's National Hospital George Washington University School of Medicine and Health Sciences Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pornchai","family":"Tirakitsoontorn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Orange County Division of Pulmonology University of California Irvine Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Arrieta","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Children's Hospital of Orange County University of California Irvine Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B.","family":"Burgener","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Los Angeles, Division of Pulmonology Keck School of Medicine at University of Southern California Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Koff","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care &amp; 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