Pulmonary exacerbations

Statement numberStatementType of statementStrength of recommendationQuality of evidenceType of patientMost relevant supporting articles
3.1CR may not help with the detection of pulmonary exacerbation, especially in CF patients with more severe disease.RecommendationGrade DLowDiagnosis[149]
3.2CT can detect acute structural lung abnormalities during and after pulmonary exacerbation (e.g. increase of bronchial wall thickening and mucus plugging) in cooperative, and uncooperative, patients.Statement of factNAHighDiagnosis[89, 95, 96, 150156]
3.3CT can be used to define outcome measures of pulmonary damage in clinical trials and test therapeutic interventions in patients with persistent respiratory symptoms and reduced lung function despite appropriate therapy.RecommendationGrade CLowDiagnosis and monitoring treatment response[55, 65, 89, 95, 96, 150154, 157]
3.4Routine use of CT for short term follow-up during pulmonary exacerbation is not recommended due to the risk of high cumulative radiation dose. Clinicians should consider the risk/benefit ratio related to dose when prescribing CT in pulmonary exacerbation.RecommendationGrade DModerateMonitoring treatment response[14, 29, 35, 36, 4044, 158]
3.5MRI can be used as a surrogate marker for disease severity and response to treatment during short-term follow-up of symptomatic, or declining, cooperative CF patients. In uncooperative patients, the risk related to moderate sedation or anaesthesia needs to be considered.RecommendationGrade AHighDiagnosis and monitoring treatment response[118, 119, 130, 136, 159]
3.6MRI can be used as a clinically relevant outcome predictor for pulmonary exacerbations in cooperative, declining CF patients.Statement of factNAHighDiagnosis and monitoring treatment response[106, 116, 119, 130, 139]

CF: cystic fibrosis; CR: chest radiograph; CT: computed tomography; MRI: magnetic resonance imaging; NA: not available.