| Cystic Fibrosis
		
			| Topic OverviewWhat is cystic fibrosis?Cystic fibrosis is a genetic
			 disease that causes
			 mucus in the body to become thick and sticky. This
			 glue-like mucus builds up and causes problems in many of the body's organs,
			 especially the
			 lungs and the pancreas. People who have cystic fibrosis can have serious breathing
			 problems and lung disease. They can also have problems with nutrition,
			 digestion, and growth. The disease generally gets worse over time. The life expectancy
			 for people with cystic fibrosis has been steadily increasing. What causes cystic fibrosis?Cystic fibrosis is one of the most common genetic disorders in white children in the United States and Canada. It's caused by a change, or
			 mutation, in a
			 gene. The changed gene is passed down in families. To
			 pass on this disease, both parents must be
			 carriers of the changed gene. What are the symptoms?Cystic fibrosis is usually
			 diagnosed at an early age. The symptoms aren't the same for everyone. But
			 some common symptoms in a baby who has cystic fibrosis include: A blocked small intestine at birth. This
				prevents the baby from passing his or her first stool. Very salty
				sweat or skin.Diarrhea.Not growing or gaining weight
				the way that other children do.Breathing problems, lung
				infections, a cough that does not go away, and wheezing.
 Other symptoms may also develop in childhood, such
			 as:  Clubbing (rounding and flattening) of the
				fingers.Rectal prolapse (when part of the
				rectum protrudes from the anus).Growths (polyps) in the
				nose or sinuses. 
 How is cystic fibrosis diagnosed? Babies in the United States and Canada are tested for cystic fibrosis right after birth.
			 Screening tests look for a certain health problem before any symptoms
			 appear. The doctor may also notice the signs of cystic fibrosis during a routine exam. If your child has a positive newborn screening test or
			 symptoms of cystic fibrosis, your doctor will order a
			 sweat test to see how much salt is in your child's sweat. People with cystic
			 fibrosis have sweat that is much saltier than normal. The doctor may also
			 suggest a genetic test. Finding a high amount of salt in two sweat tests or
			 finding certain changed genes will confirm a diagnosis. How is it treated?The types of treatment your child receives depends
			 on what kinds of health problems the cystic fibrosis is causing and how your
			 child's body responds to different types of treatment. 
			 Doctors usually recommend a combination of medicines, home treatment methods (including respiratory and nutritional
			 therapies), and other specialized care to manage the disease. Frequently Asked Questions| Learning about cystic fibrosis: |  |  | Being diagnosed: |  |  | Getting treatment: |  |  | Ongoing concerns: |  |  | Living with cystic fibrosis: |  | 
CauseCystic fibrosis
		  occurs when a child inherits a changed (mutated)
		  gene from both parents. The changed gene
		  causes problems with the way salt and water move in and out of the cells that
		  make
		  mucus, causing the mucus to be thick and sticky. This
		  kind of mucus makes it hard for the body to keep certain organs  clean and
		  healthy. Many people don't know they have
		  the changed gene. If you are the parent of a child who has cystic fibrosis, it
		  is important to remember that nothing you did caused the disease.SymptomsSymptoms of
		  cystic fibrosis are usually caused by the production
		  of thick, sticky
		  mucus throughout the body. Symptoms vary from person to person. They aren't
		  always obvious in childhood.  Early symptomsSymptoms of cystic
			 fibrosis in a baby or young child may include: A blocked small intestine at birth.Salty
				sweat or skin.Wanting to eat more or less than normal, having little energy,
				or losing weight.  Unusual bowel movements.  The child may have
				diarrhea that doesn't go away, large and greasy stools, very smelly stools, or
				constipation. If the intestines become blocked, the child's belly may stick out. The child may not be able to have a bowel movement.
Breathing
				problems or getting tired easily while playing. A cough that doesn't go away or
				wheezing.
 Later symptomsOver time, symptoms may
			 get worse and cause problems such as: Coughing up mucus that sometimes has blood in
				it.Difficulty exercising or not being able to
				exercise.Rectal prolapse, which means that part of the
				rectum protrudes from the anus.
 Other symptomsMore symptoms may develop during late childhood or
			 early adulthood. They include: Clubbing (rounding and flattening) of the
				fingers.Growths (polyps) in the nose or
				sinuses.Not being able to have children (infertility).
What Happens Although
		  cystic fibrosis generally follows certain patterns,
		  each person's symptoms depend on what is happening with his or her
		  mucus-producing cells. These kinds of cells are found throughout the body in
		  many different organs and systems, including the:  Lungs and respiratory system. People
			 with cystic fibrosis have thick and sticky mucus that traps bacteria. This
			 causes lots of lung infections and often causes permanent lung
			 damage. Bronchiectasis, which is caused by long-lasting airway
			 inflammation, is common.Pancreas and digestive system. Mucus can
			 interfere with how the
			 pancreas works. This can make it hard for the child
			 to absorb nutrients from food. Sweat glands. You may notice that your child has unusually salty skin. Cystic
			 fibrosis can cause a person to become easily
			 dehydrated or to have very low salt levels.Reproductive organs. Almost all men who have
			 cystic fibrosis are unable to father a child. Women who have cystic fibrosis  may have more difficulty getting pregnant than other
			 women.Skeletal system. People who have cystic fibrosis may
			 have weaker bones than other people. This is because their bones contain lower levels of minerals.
			 Weakened bones can lead to bone
			 fractures,
			 osteopenia, or
			 osteoporosis. Cystic fibrosis can also cause swollen
			 or painful joints (arthropathy or
			 arthritis). These problems are more common in adults
			 than in children.
 Life expectancyThe life expectancy for people
			 with cystic fibrosis has been steadily increasing. On
			 average, people who have cystic fibrosis live into their mid-to-late 30s. But new treatments are helping some people to live into
			 their 40s and longer. People who have a mild form  may have a
			 normal life expectancy. Even though cystic fibrosis can't be cured, the treatments continue to get  better. And there are new treatments that target the cystic fibrosis gene defect.What Increases Your RiskCystic fibrosis is a
		  genetic disorder. It is an
		  autosomal recessive disease. This means that to get
		  the disease, you must inherit the changed (mutated) gene from both parents.
		  Keep in mind:   If a person inherits the changed gene from
			 only one parent, he or she will not get cystic fibrosis but will be a
			 carrier of the disease. Carriers may pass the gene defect on to their children.If you are planning a
			 pregnancy and you are white, talk to your doctor about having a
			 genetic test to find out your chances of having a
			 child with cystic fibrosis. The disease is much more common in non-Hispanic white people
			 than in people of other races and ethnic backgrounds.
When To Call a DoctorIt is important to diagnose and
		  treat
		  cystic fibrosis early. Call your doctor if your
		  child: Often has lung infections (pneumonia), colds, a cough, shortness of
			 breath, or
			 wheezing.Coughs up mucus that contains
			 blood.Doesn't gain or stay at the same weight.Has smelly,
			 large, greasy stools or diarrhea.Tires easily during activity.Has rounded, flat
			 fingertips (clubbing).
  Call your doctor if your child who has been diagnosed with
		  cystic fibrosis gets worse in any way. Typically, this is when your
		  child: Has increased coughing or has a cough that is
			 getting worse.Has new wheezing or has wheezing that is getting
			 worse.Has more trouble breathing than usual.Has lost
			 weight or is not gaining weight, for no clear reason.Is having
			 symptoms that you and your doctor have discussed as being more serious
			 problems.
 Watchful waiting Watchful waiting is a wait-and-see approach. It's not a good idea for people who have cystic
			 fibrosis. If your child has any signs of cystic fibrosis, even if they seem to
			 be mild, call the doctor right away. Who to seeThe following doctors can diagnose and treat cystic
			 fibrosis: Other health professionals may also be involved in your
			 child's care: Cystic fibrosis care centers
			 offer the best, most comprehensive treatment available by addressing
			 medical, nutritional, and emotional needs.
			 You can find one by contacting the Cystic Fibrosis Foundation at
			 www.cff.org. To prepare for your appointment, see the topic Making the Most of Your Appointment.Exams and TestsTests can help find out if a person has cystic fibrosis or has the changed gene that can be passed on to a child. Adults may want to get tested during a pregnancy or when they are planning for a pregnancy. People can be tested at any age to see if they have cystic fibrosis. Diagnosis A
		  medical history and a
		  physical exam are often the first steps in diagnosing
		  cystic fibrosis, followed by screening or lab tests.   The
		  diagnosis of cystic fibrosis requires one of the
		  following: Your child has early symptoms. These may include diarrhea that does not go away; large, greasy or very
				  smelly stools;  constipation; not wanting to eat; or losing weight. To learn more, see Symptoms.A brother or sister who has cystic
			 fibrosis.A positive
			 newborn screening test.
  Also, there must be at least one of the following: A genetic test showing that a person inherited one or two defective cystic fibrosis transmembrane regulator (CFTR) genes. This testing can be done using blood or a sample from
			 the mother's womb before birth (chorionic villus sampling or
			 amniocentesis).Two positive
			 sweat tests on different dates. Sweat tests measure
			 the level of salt in sweat. People with cystic fibrosis have more than the
			 normal amount of salt in their sweat. If a genetic test detects two defective CFTR genes, then just one sweat test result may be all that is needed to confirm a diagnosis.An abnormal
			 nasal potential difference test. This test uses
			 electrodes on the lining of the nose to see how well salts flow into and out of
			 cells.
 Monitoring cystic fibrosisCertain tests can help your doctor monitor your child's cystic fibrosis.
		  These tests include: Lung function tests to find out how
			 healthy the lungs are by checking how well air moves into and out of the
			 lungs.A
			 throat culture or
			 sputum culture to see what kinds of bacteria are
			 causing any infections your child may have. A
			 chest X-ray to take a picture of the chest, including
			 the heart and lungs.A
			 CT scan to find any serious disease in the lungs,
			 pancreas, or other organs.Blood tests, such as the oral glucose tolerance test and liver function. These tests are to see if there are any
			 complications of cystic fibrosis.A
			 stool analysis to see how well your child is absorbing
			 and digesting fat and other nutrients.An
			 arterial blood gas analysis to measure the levels of
			 oxygen and carbon dioxide in the blood. This test shows how well the lungs are
			 working.
 Early detectionBoth newborns and adults can be tested for the
			 changed (mutated) gene that causes cystic fibrosis. These tests include: Newborn screening. Levels of
				a type of digestive enzyme are measured from a blood
				sample. High levels of this enzyme suggest cystic fibrosis. Some newborns may also have
				a
				genetic test.Genetic test for adults. These tests identify the most common defects in the
				CFTR gene. Genetic testing can be
				done during pregnancy through chorionic villus sampling or amniocentesis. The
				test can also be done before pregnancy, to help couples find out if
				either or both of them carry a defective CFTR gene. 
				If both parents
					 carry the changed gene, there is a 25% (1-in-4) chance that their child will
					 have no genetic problem. There is a 25% chance that their child will have cystic
					 fibrosis. And there is a 50% (1-in-2) chance that their child will be a
					 carrier. If only one
					 parent is a carrier of the changed gene, the child will not have cystic
					 fibrosis. But there is a 50% chance that the child will be a carrier.
 If you are interested in a genetic test for cystic
			 fibrosis, talk with your doctor about the test. Genetic counseling can help you understand your
			 test results. Genetic testing may involve certain ethical, legal, and religious issues.Treatment OverviewAfter a
		  child is diagnosed, a team of health professionals will build a treatment plan
		  based on the child's specific health problems. Following a treatment plan will help your child live a longer, healthier
		  life.  Your child will likely have ongoing  respiratory therapy, digestive therapy, and treatment with medicines such as antibiotics. Regular medical care, home treatment such as
		  postural drainage, and taking steps to reduce infection
		  can help people with cystic fibrosis lead relatively normal lives.  The best treatment available is generally found at cystic
		  fibrosis care centers. These centers address the
		  medical, nutritional, and emotional needs.
		  You can find one by contacting the Cystic Fibrosis Foundation at www.cff.org.
		   Doctor visits and immunizations Regular visits with
			 the team of health professionals involved in your child's care are
			 important. Your doctor will want to
			 make sure that your child is eating properly and is gaining weight and growing
			 at a normal rate. The doctor will record your child's weight, height, and head
			 size in order to keep track of how your child is developing over time. Lab tests can help your doctor know how
			 serious the disease is and how it is affecting your child's body.  Your doctor will ask you about your child's
			 immunizations and will schedule any shots that are needed.
			 Children with cystic fibrosis should have all the recommended shots, plus pneumococcal shots. To learn more, see the topic
			 Immunizations.  Respiratory therapy Respiratory therapy is any treatment that slows down
			 lung damage and improves breathing. The focus of this therapy is on reducing
			 infection and getting rid of mucus to keep the lungs healthy. Medicines may be used  to control the amount and thickness of mucus. Other ways to help remove mucus from the lungs involve
			 certain types of movements, coughing, or exercises known as airway clearance
			 techniques.  Cystic Fibrosis: Helping Your Child Cough Up Mucus
 People
			 with severe lung disease may need to use oxygen at home. Oxygen Therapy: Using Oxygen at Home
 Digestive therapy This treatment works to replace certain
			 digestive enzymes, to make sure the body absorbs all the
			 vitamins and
			 minerals it needs, and to prevent or treat intestinal
			 blockages. Digestive therapy involves: Digestive
				enzyme replacement therapy (such as with Creon or
				Pancreaze), to help the intestines absorb nutrients from food.
				Nutritional therapy to help replace lost nutrients. This may include taking
				vitamins; eating high-calorie, high-fat foods; drinking nutritional drinks;
				getting fed through a tube in the stomach; and, in some cases, receiving
				intravenous nutrient
				supplementation.Preventing intestinal blockages with stool
				softeners (to avoid constipation) and
				enemas.
 Treating complicationsSerious
			 cystic fibrosis problems or
			 complications occur when the
			 respiratory system or
			 digestive system becomes damaged. Most people who have complications will need to stay
			 in the hospital. Treatment for complications may include medicines or surgery,
			 depending on the person's age and symptoms. The doctor may do tests, such as a chest
				X-ray, to know what kinds of problems your child is having. Other treatments for complications from cystic
			 fibrosis may include: Blood transfusions and medicines to treat the bleeding (embolization therapy),
				if your child is coughing up large amounts of blood. Coughing up small amounts
				of blood is normal for people who have cystic fibrosis. But coughing up large
				amounts of blood can be life-threatening.Placement of a semipermanent intravenous (IV) tube to give your child antibiotics frequently without having to place a line
				in the vein each time.
 Home care for cystic fibrosisHome
		  treatment is very important. It can make a person with cystic fibrosis feel better and live longer. Here are some things you  can do at  home, or help your child do, to help prevent
more serious health problems like lung infections: As children with cystic fibrosis get older, it is
			 important for them to learn how to help care for themselves. Even though it can
			 be hard to follow a treatment plan every day, there are many benefits of home
			 treatments. Skipping a treatment may not make a person feel worse right away. But it raises the chances of having more serious problems later. Getting supportHandling the challenges of caring for a child who has cystic fibrosis can be difficult.
		  Take good care of yourself,
		  physically and emotionally, so that you can give your child the best care possible.  Many people with cystic fibrosis and their families need
		  emotional support to help them live with this genetic disease.
		  Support groups,
			 counseling, and education about the disease can be
			 very helpful not only for people who have cystic fibrosis but also for their
			 families.  It is also  important to talk about the kind of medical procedures you
			 want or don't want for yourself or for your child. Research for new treatmentsMedical researchers are looking at gene transfer therapy. It involves introducing
		  healthy genes into the lung cells of people who have cystic fibrosis.  Researchers are also investigating protein repair therapy, or protein
		  assist therapy. This treatment involves taking medicines that help the defective
		  protein work more normally to allow a small amount of salt and water to move
		  out of cells. Gene transfer and protein repair therapies are in
		  the experimental, developmental stages.  Talk to your doctor about clinical trials for these and other new treatments being studied.MedicationsMedicines for
		  cystic fibrosis help keep the lungs as healthy as
		  possible, reduce and control
		  mucus in the lungs, and replace digestive
		  enzymes. Medicine choicesMedicines to treat infectionsAntibiotics (such as
				  ciprofloxacin and tobramycin)
 Medicines to open airways in the lungs or keep them openBronchodilators
				  (such as albuterol or salmeterol), which are used to make breathing easier. They may also make it
				easier to cough up mucus.Anticholinergics (such as Atrovent)
 Medicines to control the amount and thickness of mucusDNase (such as
				  Pulmozyme). It is used to thin mucus
				in the lungs.Mucolytics (such as acetylcysteine), to thin mucus in the lungs and the intestines. These aren't used very
				much, though, because they can irritate the lungs. 
				  Saltwater solution (hypertonic saline). This is sometimes used to help clear mucus from the
				lungs. It is low-cost, and it may help reduce
				inflammation in the airways.footnote 1, footnote 2
 Medicines to reduce inflammationMedicines to replace the effect of digestive enzymesEnzyme replacement therapy (such as Creon or Pancreaze)
 Medicines to correct mutated genesIvacaftor (Kalydeco). A small number of people with cystic fibrosis have a certain changed (mutated) gene called the G551D mutation. If people have this changed gene and are age 6 or older, the medicine ivacaftor (Kalydeco) can target the genetic cause of the lung problems and may  help improve lung function. 
 Combination medicine (lumacaftor/ivacaftor). The most common cause of cystic fibrosis is the changed gene called the F508del mutation.  People who are 12 years or older and have two copies of this mutated gene, one from each parent, may be treated with this medicine.  It treats the cause of cystic fibrosis.   
 These medicines cost a lot, but there may be programs to help pay for them.   Talk to your doctor if you want to know more. What to think aboutSome medicines work better for
			 some people than for others. A medicine that works well for one person may not
			 work for someone else. It can take time to find the medicines that work best
			 for you or your child.SurgerySurgery may be needed to treat complications
		  of
		  cystic fibrosis. Procedures may include: If your child isn't able to get all the nutrients he or
		  she needs from food, a
		  feeding tube may be placed in your child's stomach.  What to think aboutLung transplant surgery is
			 generally recommended only for people who have severe lung damage, because the
			 risks can be greater than the benefits. Not everyone is a good candidate for an organ transplant. If tests show that you are a good candidate, you are put on a waiting list. You may have to wait days, months, or years for your transplant. Be patient, and ask your doctor what you can do while you're waiting. Guidelines from the United Network for Organ Sharing (UNOS)
			 are intended to shorten the wait time for donor lungs.  For more
			 information on transplants, see the topic
			 Organ Transplant.Other Places To Get HelpOrganizationsCystic Fibrosis Foundation (U.S.) www.cff.orgNational Heart, Lung, and Blood Institute (U.S.) www.nhlbi.nih.govReferencesCitationsElkins MR, et al. (2006). A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. New England Journal of Medicine, 354(3): 229-240.Wark P, McDonald VM. (2009). Nebulised hypertonic saline for cystic fibrosis. Cochrane Database of Systematic Reviews (2).
 Other Works ConsultedACOG Committee on Genetics (2002, reaffirmed 2006). Genetics and molecular testing. ACOG Technology Assessment in Obstetrics and Gynecology, 100(1): 193-211.American Academy of Pediatrics (2009). Nutrition in cystic fibrosis. In RE Kleinman, ed., Pediatric Nutrition Handbook, 6th ed., pp. 1001-1020. Elk Grove Village, IL: American Academy of Pediatrics.American Academy of Pediatrics (2014). Nutrition in cystic fibrosis. In Pediatric Nutrition, 7th ed., pp. 1113-1145 . Elk Grove Village, IL: American Academy of Pediatrics.American Diabetes Association (2017). Standards of medical care in diabetes-2017. Diabetes Care, 40(Suppl 1): S1-S135. http://care.diabetesjournals.org/content/40/Supplement_1. Accessed December 15, 2016.Balfour-Lynn IM, Welch K (2012). Inhaled corticosteroids for cystic fibrosis. Cochrane Database of Systematic Reviews (11).Borowitz D, et al. (2009). Cystic Fibrosis Foundation evidence-based guidelines for management of infants with cystic fibrosis. Journal of Pediatrics, 155(6): S73-S93.Boucher RC, et al. (2010). Cystic fibrosis. In R Mason et al., eds., Murray and Nadel's Textbook of Respiratory Medicine, 5th ed., vol. 1, pp. 985-1022. Philadelphia: Saunders.Dovey ME (2006). Cystic fibrosis. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 457-461. Philadelphia: Saunders Elsevier.Elkins MR, et al. (2006). A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. New England Journal of Medicine, 354(3): 229-240.Ernst MM, et al. (2011). Developmental and psychosocial issues in cystic fibrosis. Pediatric Clinics of North America, 58(4): 865-885.Farrell PM, et al. (2008). Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report. Journal of Pediatrics, 153(2): S4-S14. DOI: 10.1016/j.jpeds.2008.05.005. Accessed January 26, 2017.Flume PA, et al. (2009). Cystic fibrosis pulmonary guidelines: Airway clearance therapies. Respiratory Care, 54(4): 522-537.Flume PA, et al. (2009). Cystic fibrosis pulmonary guidelines: Treatment of pulmonary exacerbations. American Journal of Respiratory and Critical Care Medicine, 180(9): 802-808.Grosse SD, et al. (2004). Newborn screening for cystic fibrosis: Evaluation of benefits and risks and recommendations for state newborn screening programs. MMWR, 53(RR-13): 1-36. Gustafsson PM, et al. (2008). Multiple-breath inert gas washout and spirometry versus structural lung disease in cystic fibrosis. Thorax, 63(2): 129-134.Jones AP, Wallis C (2010). Dornase alfa for cystic fibrosis. Cochrane Database of Systematic Reviews (3).Nash EF, et al. (2009). Nebulized and oral thiol derivatives for pulmonary disease in cystic fibrosis. Cochrane Database of Systematic Reviews (1).Organ Procurement and Transplantation Network (2013). Organ distribution: Allocation of thoracic organs, Policy 3.7. Available online: http://optn.transplant.hrsa.gov/policiesAndBylaws/policies.asp. Ratjen F, McColley S (2012). Update in cystic fibrosis 2011. American Journal of Respiratory and Critical Care Medicine, 185(9): 933-936.Southern KW, et al. (2009). Newborn screening for cystic fibrosis. Cochrane Database of Systematic Reviews (1).Wark P, McDonald VM. (2009). Nebulised hypertonic saline for cystic fibrosis. Cochrane Database of Systematic Reviews (2).
CreditsByHealthwise StaffPrimary Medical ReviewerJohn Pope, MD - Pediatrics
 Kathleen Romito, MD - Family Medicine
 Specialist Medical ReviewerR. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care Medicine, Medical Toxicology
Current as of:
                May 4, 2017Elkins MR, et al. (2006). A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. New England Journal of Medicine, 354(3): 229-240. Wark P, McDonald VM. (2009). Nebulised hypertonic saline for cystic fibrosis. Cochrane Database of Systematic Reviews (2). Last modified on: 8 September 2017  |  |