In people with cystic fibrosis, thickened secretions block the normal flow of the digestive juices from the pancreas. This can result in food not being digested or absorbed properly, in particular, fatty foods and fat-soluble vitamins (vitamins A, D, E and K). This can cause:
- Malnutrition leading to poor growth and poor weight gain (even if you have a good appetite and eat a lot, as the problem is with digesting and absorbing the food).
- Large, smelly, greasy, fatty faeces (stools or motions) occur in about a third of cases.
- Bloated abdomen.
In about 3 in 20 cases the pancreas functions well and there are no or minimal gut symptoms, and mainly just lung symptoms.
Symptoms sometimes occur at birth
About 1 in 10 children with cystic fibrosis are diagnosed shortly after birth. This is due to a condition called meconium ileus where in some cases the gut becomes blocked with meconium - a thick, dark, sticky substance which is made by the baby's gut before being born. Urgent surgery may be needed to relieve the blockage.
Other symptoms and complications
Other organs may be affected which may cause various other problems in some cases. Also, the pancreas and airways may become severely affected. Therefore, other problems which may also occur in some cases include:
- Repeated sinus infections.
- Polyps forming in the nose.
- Infertility (especially in males as the tubes which carry the sperm can become blocked).
- Damage to the liver which may lead to cirrhosis occurs in about 1 in 12 cases (if the small ducts in the liver become blocked or damaged).
- Diabetes. (Special cells in the pancreas make insulin. If the pancreas becomes severely damaged over time then insulin levels go down and diabetes may develop.) This is rare in children but is more common in adults who have had cystic fibrosis for years.
- Pancreatitis (inflammation of the pancreas).
- Rectal prolapse.
- Constipation.
- Osteoporosis (thinning of the bones) may develop due to poor absorption of food, and in particular, poor absorption of vitamin D which is needed to maintain healthy bones.
- The sweat tastes very salty.
General
Ongoing poor nutrition combined with persistent lung symptoms and repeated chest infections often causes 'failure to thrive' in young children, delayed maturation and sexual development in teenagers, and general poor health at any age.
Mild cases
Recently, some cases of cystic fibrosis have been diagnosed in adults who have relatively mild symptoms. This may be due to some mutations of the cystic fibrosis gene not being as 'faulty' as others. The handling of sodium and chloride may only be mildly affected in these cases.
How is cystic fibrosis diagnosed?
Sweat test
A doctor may arrange a sweat test if he or she suspects cystic fibrosis from the symptoms. This test measures the amount of salt (sodium and chloride) in skin sweat. People with cystic fibrosis have an abnormally high salt level in sweat.
Genetic test
A genetic test can confirm the diagnosis. Some cells are scrapped from the inside of the cheek. These can be tested to detect the cystic fibrosis gene.
Screening test
Some countries screen all newborn babies for cystic fibrosis. A small 'heel prick' blood test is taken about the sixth day after birth. This can detect a chemical called immunoreactive trypsin which is high in babies with cystic fibrosis. If it is high then a sweat test and genetic test can be done to confirm the diagnosis.
There are very good arguments to screen all babies as the earlier the diagnosis is made, the sooner treatment can begin which improves the outlook (prognosis). However, only a few places in the UK routinely screen newborn babies for cystic fibrosis. This may change in the future and screening may be introduced to include all areas in the UK.
What is the treatment for cystic fibrosis?
There are many aspects to the treatment of people with cystic fibrosis. Treatment involves the input, advice, and expertise of various professionals such as child health doctors, specialist nurses, physiotherapists, dieticians, etc. It is usual to have regular checks and tests to monitor the condition and to keep a check on children's growth, development and well-being.
The following list is a brief overview of the commonly used treatments, but is not a full or exhaustive account of all the treatments used. An individual treatment plan is needed for each case to take into account individual circumstances.
Treatments for lung problems
Physiotherapy and exercise
Regular chest physiotherapy is very important. This helps to clear the airways of the thick mucus. A physiotherapist usually shows parents how to do this for their children. It involves a special way to firmly pat the chest whilst the child lies head-down to encourage mucus and sputum to be coughed out. Twice daily chest physiotherapy is common practice. This may need to be increased during times of chest infections. It is also important to encourage children to exercise and to be as active and fit as possible. So, sports and games are encouraged.
Antibiotics and antifungals
Courses of antibiotics are a mainstay of treatment. Many children with cystic fibrosis take regular long-term antibiotics. The dose is increased and/or other types of antibiotics are given when a chest infection develops. Various bacteria can cause infections and the antibiotics chosen depend on which bacteria are found in samples of sputum. Antibiotics given intravenously (into a vein) are often required for severe infections that are not controlled with antibiotic tablets.
A bacterium called pseudomonas aeruginosa commonly persists in the thick mucus in the airways. To keep this from flaring up into repeated infections, an antibiotic given by nebuliser (inhaled antibiotic) is a common treatment.
Sometimes the lungs become infected with a fungus and antifungal medication is required.
Inhalers
Inhalers to 'open up the airways' as much as possible may be used. This is similar to the treatment used for asthma.
Dornase alfa
This is a drug given by nebuliser in some cases. It helps to break down and to 'thin' the thick mucus making it easier to cough up and clear the mucus from in the airways. It may reduce the number of lung infections and help to improve lung function.
Oxygen
People with advanced lung disease may benefit from oxygen, particularly overnight.
Treatment for pancreatic problems
Nutrition
The enzymes needed to digest food are greatly reduced in most people with cystic fibrosis. Therefore children with cystic fibrosis need a high fat and carbohydrate diet. A dietician will usually give detailed advice. High energy food and drink supplements may also be needed. In addition, vitamin supplements are needed as many vitamins in food are not absorbed very well.
Enzyme supplements
In most cases, enzyme supplements are needed to help to digest food. (These replace the enzymes which normally come from the pancreas.) You need to take these supplements every time you eat food. This can mean taking many doses each day.
Other treatments
A range of other problems which are related to cystic fibrosis may develop in some cases and require treatment. For example:
- Salt depletion may occur in hot weather and may require salt supplements.
- Liver problems develop in some cases and may require specialist liver treatments.
- If diabetes develops it usually requires insulin treatment.
- Nasal polyps sometimes develop and can be treated with steroid nasal drops and sprays.
- Acid reflux from the stomach into the gullet (oesophagus) is common and can be treated with medicines which reduce the acid content of the stomach juices.
- Constipation is quite common and may require regular laxatives.
- All people with cystic fibrosis should be up to date with routine immunisations, and also have an annual 'flu jab' to prevent influenza.
Newer treatments are being researched and developed and if found successful may become more widely used in the future. For example:
- A lung transplant has been used in some cases and may become more common.
- Gene therapy. This involves using an inhaled spray to deliver normal copies of the cystic fibrosis gene to the lungs.
- Drugs are being tested which may correct the abnormal salt and water regulation of cells that leads to thickened mucus and secretions being made in the lungs and other organs.
What is the outlook (prognosis)?
Cystic fibrosis is a lifelong condition. With improved treatment there has been a dramatic increase in the survival of people with cystic fibrosis over the last 20 years or so. In the 1960's and before, most babies born with cystic fibrosis only survived for a few months or years. Today, many people with cystic fibrosis are living into their 30's and beyond. With optimal care and treatment, it is estimated that about 8 in 10 of today's children with cystic fibrosis should live into their mid 40's. With treatment, most people with cystic fibrosis can live reasonably normal and productive lives.
However, there will be times when symptoms are more severe, mainly when a chest infection develops. Even with treatment, the main risk is recurring chest infections, and pneumonia. This can have a recurring damaging effect on lung function which can get worse over time. Death in childhood or early adulthood is still not uncommon. Most people with cystic fibrosis die of lung complications, mainly respiratory failure.
Genetic counselling
People with a family history of cystic fibrosis may wish to have genetic counselling and testing to find out their risk of passing the condition on to their children. A simple test can be done to some cells which are scrapped from the inside of the cheek. The test can detect the cystic fibrosis gene which can show if you are a 'carrier' of the abnormal gene.
Further help and information
Cystic Fibrosis Trust 11 London Road, Bromley, Kent, BR1 1BY
Tel: 020 8464 7211 Web:
www.cftrust.org.ukProvides information and support for people with cystic fibrosis and their carers.
©EMIS and PIP 2004
