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Clinical Investigations: CYSTIC FIBROSIS |

Massive Hemoptysis in Cystic Fibrosis*

Patrick A. Flume, MD, FCCP; James R. Yankaskas, MD, FCCP; Myla Ebeling, BS; Thomas Hulsey, MSPH, ScD; Leslie L. Clark, MS
Author and Funding Information

*From the Departments of Medicine (Dr. Flume), Pediatrics (Ms. Ebeling and Dr. Hulsey), and Biometry and Epidemiology (Ms. Clark), Medical University of South Carolina, Charleston, SC; and Department of Medicine (Dr. Yankaskas), University of North Carolina at Chapel Hill, Chapel Hill, NC.

Correspondence to: Patrick A. Flume, MD, FCCP, Medical University of South Carolina, 96 Jonathan Lucas St, 812-CSB, Charleston, SC 29425; e-mail: flumepa@musc.edu



Chest. 2005;128(2):729-738. doi:10.1378/chest.128.2.729
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Background: Massive hemoptysis is a complication commonly reported in patients with cystic fibrosis (CF). An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with CF.

Objectives: To identify risk factors associated with massive hemoptysis, and to determine the prognosis of patients following an episode of massive hemoptysis.

Design: A retrospective, observational cohort study of the National CF Patient Registry between the years 1990 to 1999.

Patients: The Registry contained data on 28,858 patients with CF observed over 10 years at CF centers across the United States.

Results: Massive hemoptysis occurred with an average annual incidence of 0.87% and in 4.1% of patients overall. There was no increased occurrence by sex, but it was more prevalent in older patients (mean age, 24.2 ± 8.7 years [± SD]) with more severe pulmonary impairment (nearly 60% of patients who had an episode of massive hemoptysis had FEV1 < 40% predicted). The principal risks associated with an increased occurrence of massive hemoptysis included the presence of Staphylococcus aureus in sputum cultures (odds ratio [OR], 1.3) and diabetes (OR, 1.1). There was an increased morbidity (eg, increased hospitalizations and hospital days) and an increased 2-year mortality following massive hemoptysis.

Conclusion: Massive hemoptysis is a serious complication in CF patients, occurring more commonly in older patients with more advanced lung disease. Nearly 1 in 100 patients will have this complication each year. There is an attributable mortality to the complication and considerable morbidity, resulting in increased health-care utilization and a measurable decline in lung function.

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