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Cystic Fibrosis

Cystic Fibrosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Cystic fibrosis (CF) is an autosomal recessive genetic mutation (CFTR gene) that most prominently affects the pulmonary and pancreatic systems.
  • The GI, endocrine, and reproductive systems as well as the liver, sinuses, and skin can all be involved.
  • Initially a pediatric disease, CF has become a chronic pediatric and adult medical condition as improvements in medical care have led to a dramatic increase in long-term survival resulting in adults living with the disease outnumbering children in 2014 (1)[A].

Epidemiology

CF is the most common lethal inherited disease in Caucasians and is found in every racial group.


Incidence

Number of infants born with CF in relation to the total number of live births in the United States

  • 1 in 3,000 Caucasians
  • 1 in 4,000 to 10,000 Latin Americans
  • 1 in 15,000 to 20,000 African Americans
  • 1 in 30,000 Asian Americans

Prevalence
30,000 patients with CF living in the United States

Etiology and Pathophysiology

  • Primary defect is abnormal function of an epithelial chloride channel protein encoded by the CFTR gene on chromosome band 7q31.2. Abnormal CFTR function leads to abnormally viscous secretions that alter organ function.
  • The lungs: Obstruction, infection, and inflammation negatively affect lung growth, structure, and function.
    • Decreased mucociliary clearance
    • Infection is accompanied by an intense neutrophilic response.
    • Degradation of supporting tissues causes bronchiectasis and eventual failure.

Genetics
CFTR gene (CF transmembrane conductance regulator). >1,500 mutations exist that can cause varying severity of phenotypic CF, all of which are recessively inherited. Most common is loss of the phenylalanine residue at 508th position (deltaF508), which accounts for 8.7% of affected alleles in the CF population in the United States. G551D mutation accounts for 4.3% of affected alleles.

Risk Factors

  • CF is a single-gene disorder. The severity of the phenotype can be affected by the specific CFTR mutation (most predictive of pancreatic disease), other modifier genes (CFTM1 for meconium ileus), gastroesophageal reflux disease (GERD), severe respiratory virus infection, and environmental factors such as tobacco smoke exposure.
  • Preconception counseling
    • American Congress of Obstetricians and Gynecologists (ACOG) recommends preconception or early (1st/2nd trimester) genetic analysis for all North American couples planning a pregnancy, with appropriate counseling to identified carriers and genetic analysis of siblings of known CF patients.
    • Universal newborn screening (NBS) has been integral in early diagnosis (64% of new CF diagnosis in 2014 were found by NBS). Patients diagnosed prior to onset of symptoms have better lung function and nutritional outcomes and should receive referral and early intervention services by an accredited regional CF center.
Pregnancy Considerations
  • Pulmonary disease may worsen during pregnancy.
  • CF may cause increased incidence of preterm delivery, IUGR, and cesarean section (2)[A].
  • Advances in fertility treatments now allow men with CF to father children (1)[A].

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Citation

Stephens, Mark B., et al., editors. "Cystic Fibrosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116162/all/Cystic_Fibrosis.
Cystic Fibrosis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116162/all/Cystic_Fibrosis. Accessed April 21, 2019.
Cystic Fibrosis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116162/all/Cystic_Fibrosis
Cystic Fibrosis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116162/all/Cystic_Fibrosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cystic Fibrosis ID - 116162 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116162/all/Cystic_Fibrosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -