{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:54:05Z","timestamp":1774958045489,"version":"3.50.1"},"reference-count":30,"publisher":"European Respiratory Society (ERS)","issue":"1","license":[{"start":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T00:00:00Z","timestamp":1556150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1000896"],"award-info":[{"award-number":["APP1000896"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP102055"],"award-info":[{"award-number":["APP102055"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006501","name":"Cystic Fibrosis Foundation Therapeutics","doi-asserted-by":"publisher","award":["SLYA04"],"award-info":[{"award-number":["SLYA04"]}],"id":[{"id":"10.13039\/100006501","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006501","name":"Cystic Fibrosis Foundation Therapeutics","doi-asserted-by":"publisher","award":["STICKA010"],"award-info":[{"award-number":["STICKA010"]}],"id":[{"id":"10.13039\/100006501","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2019,4,9]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pulmonary inflammation and infection are important clinical and prognostic markers of lung disease in cystic fibrosis (CF). However, whether in young children they are transient findings or have cumulative, long-term impacts on respiratory health is largely unknown. We aimed to determine whether their<jats:italic>repeated<\/jats:italic>detection has a deleterious effect on structural lung disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients aged &lt;6\u2005years with annual computed tomography (CT) and bronchoalveolar lavage (BAL) were included. Structural lung disease on CT (%Disease) was determined using the PRAGMA-CF (Perth\u2013Rotterdam Annotated Grid Morphometric Analysis for CF) method. The number of times free neutrophil elastase (NE) and infection were detected in BAL were counted, to determine cumulative BAL history. Linear mixed model analysis, accounting for repeat visits and adjusted for age, was used to determine associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>265 children (683 scans) were included for analysis, with BAL history comprising 1161 visits. %Disease was significantly associated with the number of prior NE (0.31, 95% CI 0.09\u20130.54; p=0.007) but not infection (0.23, 95% CI \u22120.01\u20130.47; p=0.060) detections. Reference equations were determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pulmonary inflammation in surveillance BAL has a cumulative effect on structural lung disease extent, more so than infection. This provides a strong rationale for therapies aimed at reducing inflammation in young children.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.01771-2018","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T20:11:21Z","timestamp":1556223081000},"page":"1801771","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":56,"title":["The cumulative effect of inflammation and infection on structural lung disease in early cystic fibrosis"],"prefix":"10.1183","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3727-5131","authenticated-orcid":false,"given":"Tim","family":"Rosenow","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0618-2661","authenticated-orcid":false,"given":"L. Clara","family":"Mok","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lidija","family":"Turkovic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke J.","family":"Berry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter D.","family":"Sly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarath","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harm A.W.M.","family":"Tiddens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen M.","family":"Stick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"81","published-online":{"date-parts":[[2019,4,25]]},"reference":[{"key":"2024102100553492000_54.1.1801771.1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200901-0069OC"},{"key":"2024102100553492000_54.1.1801771.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301725"},{"key":"2024102100553492000_54.1.1801771.3","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.165.7.2010139"},{"key":"2024102100553492000_54.1.1801771.4","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.20294"},{"key":"2024102100553492000_54.1.1801771.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2008.01.002"},{"key":"2024102100553492000_54.1.1801771.6","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201109-1631OC"},{"key":"2024102100553492000_54.1.1801771.7","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201011-1892OC"},{"key":"2024102100553492000_54.1.1801771.8","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201407-1277OC"},{"key":"2024102100553492000_54.1.1801771.9","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00622-2015"},{"key":"2024102100553492000_54.1.1801771.10","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201501-0061OC"},{"key":"2024102100553492000_54.1.1801771.11","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir399"},{"key":"2024102100553492000_54.1.1801771.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2009.05.005"},{"key":"2024102100553492000_54.1.1801771.13","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v067.i01"},{"key":"2024102100553492000_54.1.1801771.14","doi-asserted-by":"crossref","first-page":"13","DOI":"10.18637\/jss.v082.i13","article-title":"lmerTest: tests in linear mixed effects models","volume":"82","author":"Kuznetsova","year":"2017","journal-title":"J Stat Softw"},{"key":"2024102100553492000_54.1.1801771.15","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. Vienna, R Foundation for Statistical Computing, 2014."},{"key":"2024102100553492000_54.1.1801771.16","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200603-343OC"},{"key":"2024102100553492000_54.1.1801771.17","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2011-200912"},{"key":"2024102100553492000_54.1.1801771.18","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00043108"},{"key":"2024102100553492000_54.1.1801771.19","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201404-166OC"},{"key":"2024102100553492000_54.1.1801771.20","doi-asserted-by":"publisher","DOI":"10.1007\/BF02191510"},{"key":"2024102100553492000_54.1.1801771.21","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200304-505SO"},{"key":"2024102100553492000_54.1.1801771.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2005.05.018"},{"key":"2024102100553492000_54.1.1801771.23","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00009605"},{"key":"2024102100553492000_54.1.1801771.24","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)91446-2"},{"key":"2024102100553492000_54.1.1801771.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2011.06.002"},{"key":"2024102100553492000_54.1.1801771.26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.954"},{"key":"2024102100553492000_54.1.1801771.27","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00903-2016"},{"key":"2024102100553492000_54.1.1801771.28","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201207-1160OE"},{"key":"2024102100553492000_54.1.1801771.29","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200702-181OC"},{"key":"2024102100553492000_54.1.1801771.30","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit578"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.01771-2018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T07:38:07Z","timestamp":1740382687000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.01771-2018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,25]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,7,11]]},"published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1183\/13993003.01771-2018"],"URL":"https:\/\/doi.org\/10.1183\/13993003.01771-2018","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,25]]}}}