Epidemiology of the Nasal Flora at the Reference Center for Cystic Fibrosis of Queen Fabiola Children's University Hospital. (FLONAMUC)

Cystic fibrosis (CF) is the most common autosomal recessive inherited genetic disorder in North America, Australia and Europe.

CF is due to cystic fibrosis transmembrane conductance regulator gene mutation (CFTR) coding for a chloride channel located at the apical membrane of epithelial cells. The most common mutation is the deletion of the amino acid phenylalanine at the codon 508 (ΔF508) affecting 70% of the patients.

The CFTR channel participates in the regulation of the volume and composition of exocrine secretions. At the level of the lungs, this results in a thickening of the mucus with a dysfunction of the mucociliary clearance promoting colonization of pathogenic microorganisms. Patients with cystic fibrosis therefore have a natural susceptibility to develop acute and then chronic respiratory infections, gradually leading to irreversible respiratory tract lesions called bronchiectasis. Different germs such as Haemophilus influenzae and Staphylococcus aureus colonize the airways early in life. The progression of the disease causes furthermore a colonization by opportunistic germs such as Pseudomonas aeruginosa and Burkholderia cepacia, which are associated with higher mortality.

Pulmonary exacerbation is a common complication of CF requiring administration of antibiotics. The choice of these antibiotics depends on the germs that the patient carries in his respiratory tract.

The type of sampling and the conditions under which they are taken are therefore very important. Sputum and oropharyngeal smear are used in adolescents and children respectively to collect respiratory secretions in clinical routine. The recent literature describes induced sputum, obtained after a physiotherapy session and a hypertonic serum aerosol, as superior to the oropharyngeal smear alone and equivalent to bronchoalveolar lavage for the evaluation of the microbiological profile of patients who cannot expectorate. However, this technique takes time and requires the presence of a physiotherapist.

Bronchoalveolar lavage is reserved for complex cases that do not respond to standard treatments.

Finally, the nasal flora appears to be involved in the colonization of the lower respiratory tract. Sinuses are described as reservoirs of germs that can induce a recolonization of the lungs despite eradication of the germ (for example after a pulmonary transplantation) .

To our knowledge, no study has investigated the involvement of nasal flora in the clinical course of children with CF.

Study Overview

• Status: Unknown
• Conditions: Cystic Fibrosis
• Intervention / Treatment: Procedure: nasopharyngeal swab versus nasal wash

• Study Type: Interventional
• Enrollment (Anticipated): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Belgium
  • Brussels, Belgium, 1020
    • Hôpital Universitaire des Enfants Reine Fabiola

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 20 years (ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Cystic fibrosis patients aged 0-20y followed in Cystic fibrosis at HUDERF
• For each participant, both parents or legally acceptable representative(s) must sign an informed consent form (ICF) indicating that they understand the purpose of, and procedures required for, the study and is willing to allow the child to participate in the study.
• Assent is also required of children capable of understanding the study (typically participants 7 years of age and older).

Exclusion Criteria:

Any clinical situation that prohibit the taking of samples as defined in this protocol:

• Severe respiratory distress
• An altered state of consciousness
• A pulmonary complication contrary to the realization of respiratory physiotherapy (pneumothorax, hemoptysis).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: DIAGNOSTIC
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Nasal flora in CF patient	Procedure: nasopharyngeal swab versus nasal wash; The type of procedure will be determine according to patient collaboration

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
concordance between the microbiological results obtained by nasal lavage or swab and sputum in children	To see if there is any correlation in the cultures of pathogens present in the upper and lower respiratory tracts for any combination of samples taken	Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Impact of upper respiratory microbial flora in the patient clinical course	To see if there is any correlation between the presence of pathogens in upper respiratory tract (URT) and the alteration of one or more clinical parameters at the time of sampling (BMI, FEV1, FVC, FEF25/75, Number of exacerbations)	Day 60
Safety evaluation of the of the different methods of sampling	Type, frequency, severity and relationship between adverse events observed and sampling procedures performed.	Day 1
Tolerance of the different methods of sampling	Pain / discomfort score induced by the set of sampling procedures measured by means of the "Visual Analogue Scale" (VAS) in children aged 5 or older. The Visual Analogue Scale (VAS) consists of a straight line with the endpoints defining extreme limits such as 'no pain at all' (0) and 'pain as bad as it could be' (10). The patient is asked to mark his pain level on the line between the two endpoints. The distance between 'no pain at all' and the mark then defines the subject's pain.	Day 1
Tolerance of the different methods of sampling	Pain / discomfort score induced by the set of sampling procedures measured by means of the FLACC scale (Face, Legs, Activity, Cry, Consolability Scale) in children less than 5 years. FLACC scale is a measurement used to assess pain for children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain. The scale is scored in a range of 0-10 with 0 representing no pain. The scale has five criteria, which are each assigned a score of 0, 1 or 2. The criteria evaluated are expression of the face, position of the legs, patient activity, type of cry, consolability	Day 1
Tolerance of the different methods of sampling	Percentage of Drop-out for refusal of nasal sampling	Day 60

Collaborators and Investigators

• Sponsor: Queen Fabiola Children's University Hospital
• Investigators: Principal Investigator: Jean-Christophe Beghin, MD, Queen Fabiola Children's University Hospital

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 6, 2019
• Primary Completion (ANTICIPATED): April 30, 2020
• Study Completion (ANTICIPATED): April 30, 2020

Study Registration Dates

• First Submitted: March 4, 2019
• First Submitted That Met QC Criteria: April 9, 2019
• First Posted (ACTUAL): April 11, 2019

Study Record Updates

• Last Update Posted (ACTUAL): April 16, 2019
• Last Update Submitted That Met QC Criteria: April 11, 2019
• Last Verified: March 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Respiratory Tract Diseases; Lung Diseases; Infant, Newborn, Diseases; Genetic Diseases, Inborn; Pancreatic Diseases; Fibrosis; Cystic Fibrosis
• Other Study ID Numbers: P2018/PNEUMO/FLONAMUC

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No