Skip to main content
SpringerLink
Log in

Predictive value of the modified Bhalla score for assessment of pulmonary exacerbations in adults with cystic fibrosis

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The objective of this study was to analyze the predictive value of the modified Bhalla score in high-resolution computed tomography (HRCT) for assessment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients. We also describe the relationship between this score and pulmonary function test results.

Methods

We performed a multicenter and prospective study where adult patients with CF were included consecutively over 18 months. All patients underwent HRCT with acquisition in inspiration and expiration. The results were analyzed by an expert radiologist who assigned a modified Bhalla score value. Lung function was also assessed, and clinical variables were collected. Follow-up lasted approximately 1 year, and PEx were registered.

Results

The study population comprised 160 subjects selected from 360 CF patients monitored in the participating CF units. The mean age was 28 years, 47.5% were women, and mean forced expiratory volume in 1 s (FEV1) was 67.5%. The mean global modified Bhalla score was 14.5 ± 0.31 points. Pulmonary function test (PFT) results and the modified Bhalla score correlated well, mainly forced vital capacity (FVC) and FEV1. We constructed a statistical model based on the overall Bhalla score to predict the number of PEx.

Conclusions

The overall modified Bhalla score can predict future PEx in CF patients. This useful tool can help to prevent PEx in higher risk patients.

Key Points

• Pulmonary function test results and the modified Bhalla score correlated well with FVC and FEV1.

• The total modified Bhalla score can predict the number of exacerbations in adult CF patients.

• Our findings highlight the need to establish a unified protocol for chest HRCT during the follow-up of adult patients with CF in order to anticipate possible complications and determine their impact on pulmonary function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Salcedo-Posadas A, Gartner S, Girón-Moreno RM, García-Novo MD (2012) Tratado de Fibrosis Quística. Justim, Madrid

    Google Scholar 

  2. Jong P, Nakano Y, Lequin MH, Mayo JR, Woods R, Dare P et al (2004) Progressive damage on high resolution computed tomography despite stable lung function in cystic fibrosis. Eur Respir J 23:93–97

    Article  Google Scholar 

  3. Loeve M, Gerbrands K, Hop W, Rosenfeld M, Hartmann I, Tiddens H (2011) Bronchiectasis and pulmonary exacerbations in children and young adults with cystic fibrosis. Chest 140(1):178–115

    Article  Google Scholar 

  4. Pettit RS, Fellner C (2014) CFTR modulators for the treatment of cystic fibrosis. P T 39(7):500–511

    PubMed  PubMed Central  Google Scholar 

  5. Davies J, Alton E (2009) Monitoring respiratory disease severity in cystic fibrosis. Respir Care 54(5):606–615

    Article  Google Scholar 

  6. Loeve M, Hop W, Bruijne M (2012) Chest computed tomography scores are predictive of survival in patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med 185(10):1096–1103

    Article  Google Scholar 

  7. Demirkazık FB, Ariyurek OM, Ozcelik U, Gocmen A, Hassanabd HK, Kiper N (2001) High resolution CT in children with cystic fibrosis: correlation with pulmonary functions and radiographic scores. Eur J Radiol 37:54–59

    Article  Google Scholar 

  8. Justicia JL, Solé A, Quintana-Gallego E et al (2015) Management of pulmonary exacerbations in cystic fibrosis: still an unmet medical need in clinical practice. Expert Rev Respir Med 9(2):183–194

  9. Tepper L, Utens E, Caudri D et al (2013) Impact of bronchiectasis and trapped air on quality of life and exacerbations in cystic fibrosis. Eur Respir J 42:371–379

  10. Kilcoyne A, Lavelle P, McCarthy CJ et al (2016) Chest CT abnormalities and quality of life: relationship in adult cystic fibrosis. Ann Transl Med 4(5):87

  11. Barrio MI, García G, Gartner S y Grupo de trabajo de Fibrosis Quística (2009) Protocol for the diagnosis and follow up of patients with cystic fibrosis. An Pediatr (Barc) 71(3):250–264

  12. Máiz L, Baranda F, Coll R et al (2001) SEPAR (Spanish Society of Pneumology and Thoracic Surgery) Guidelines. Guideline for diagnosis and treatment of respiratory involvements in cystic fibrosis. Arch Bronconeumol 37:316–324

  13. Cantón R, Máiz L, Escribano A et al (2015) Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients. Arch Bronconeumol 51(3):140–150

  14. Cademartiri F, Luccichenti G, Palumbo AA et al (2008) Predictive value of Chest CT in patients with cystic fibrosis: a single center 10-year experience. AJR Am J Roentgenol 190:1475–1480

  15. Bhalla M, Turcios N, Aponte V et al (1991) Cystic fibrosis: scoring system with thin-section CT. Radiology 179:783–788

  16. Albi G, Rayón-Aledo JC, Caballero P, Rosado P y García-Esparza E (2012) Cystic fibrosis in images: the Bhalla scoring system for computed tomography in paediatric patients. Radiología. 54(3):260–268

  17. Ibrahim M, Elborn J, Rendall J, Parkins M (2010) Clinical features and outcomes of cystic fibrosis pulmonary exacerbations presenting with normal inflammatory markers. J Cyst Fibros S56

  18. Schechter M (2018) Reevaluating approaches to cystic fibrosis pulmonary exacerbations. Pediatr Pulmonol 53(S3):S51–S63

    Article  Google Scholar 

  19. Girón-Moreno RM, Justicia JL, Yamamoto S et al (2014) Role of C-reactive protein as a biomarker for prediction of the severity of pulmonary exacerbations in patients with cystic fibrosis. BMC Pulm Med 14:150

  20. Rabin HR, Butler SM, Wohl ME et al (2004) Epidemiologic study of cystic fibrosis. Pulmonary exacerbations in cystic fibrosis. Pediatr Pulmonol 37(5):400–406

  21. Martínez González MA, Faulin FJ, Sánchez A (2014) Bioestadística amigable. 3° edición. Elsevier, Spain

    Google Scholar 

  22. Horsley A, Siddiqui S (2015) Putting lung function and physiology into perspective: cystic fibrosis in adults. Respirology 20(1):33–45

    Article  Google Scholar 

  23. Judge EP, Dodd JD, Masterson JB, Gallagher CG (2006) Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis. Chest 130:1424–1432

    Article  Google Scholar 

  24. Brody AS, Sucharew H, Campbell JD et al (2005) Computed tomography correlates with pulmonary exacerbations in children with cystic fibrosis. Am J Respir Crit Care Med 172(9):1128–1132

  25. Loeve M, van Hal P, Robinson P et al (2009) The spectrum of structural abnormalities on CT scans from patients with CF with severe advanced lung disease. Thorax 64:876–882

  26. Sanders DB, Li Z, Brody AS (2015) Chest computed tomography predicts the frequency of pulmonary exacerbations in children with cystic fibrosis. Ann Am Thorac Soc 12(1):64–69

    Article  Google Scholar 

  27. Tiddens H, Puderbach M, Venegas J et al (2015) Novel outcome measures for clinical trials in cystic fibrosis. Pediatr Pulmonol 50:302–315

Download references

Funding

This study has received funding by “Beca ayuda a la investigación SEPAR.”

Author information

Authors and Affiliations

  1. Respirology Service, Hospital Universitario La Princesa, Madrid, Spain

    Layla Diab-Cáceres, Rosa María Girón-Moreno, Elena García-Castillo, Maria Teresa Pastor-Sanz, Rosa Mar Gómez-Punter & Julio Ancochea

  2. Respirology Service, Hospital Regional Universitario de Málaga, Málaga, Spain

    Casilda Olveira

  3. Respirology Service, Hospital Central de Asturias, Oviedo, Spain

    Marta María García-Clemente

  4. Respirology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Rosa Nieto-Royo

  5. Respirology Service, Hospital Universitario La Paz, Madrid, Spain

    Concha Prados-Sánchez

  6. Radiodiagnostic Service, Hospital Universitario La Princesa, Madrid, Spain

    Paloma Caballero-Sánchez & Maria Jose Olivera-Serrano

  7. Radiodiagnostic Service, Hospital Regional Universitario de Málaga, Málaga, Spain

    Alicia Padilla-Galo

  8. Radiodiagnostic Service, Hospital Central de Asturias, Oviedo, Spain

    Encarnacion Nava-Tomas

  9. Radiodiagnostic Service, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Amparo Esteban-Peris

  10. Radiodiagnostic Service, Hospital Universitario La Paz, Madrid, Spain

    Maria Fernández-Velilla & Maribel Torres

Authors
  1. Layla Diab-Cáceres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosa María Girón-Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elena García-Castillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Teresa Pastor-Sanz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Casilda Olveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marta María García-Clemente
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rosa Nieto-Royo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Concha Prados-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paloma Caballero-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maria Jose Olivera-Serrano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alicia Padilla-Galo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Encarnacion Nava-Tomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Amparo Esteban-Peris
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Maria Fernández-Velilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Maribel Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Rosa Mar Gómez-Punter
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Julio Ancochea
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Layla Diab-Cáceres.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Layla Diab Cáceres.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (Maria Teresa Pastor Sanz).

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• multicenter study

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Diab-Cáceres, L., Girón-Moreno, R.M., García-Castillo, E. et al. Predictive value of the modified Bhalla score for assessment of pulmonary exacerbations in adults with cystic fibrosis. Eur Radiol 31, 112–120 (2021). https://doi.org/10.1007/s00330-020-07095-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-07095-y

Keywords

Search

Navigation