Lung ultrasound in the management of patients with cystic fibrosis: A literature review

Purpose

Adults and children diagnosed with cystic fibrosis (CF) are regularly exposed to ionising radiation, from chest radiographs (CXR) and computed tomography (CT). This poses an issue as life expectancy has increased into the fifth decade of life.

Lung ultrasound (LUS) has the ability to assess many lung pathologies experienced in CF with accuracy close to CT but without the exposure to ionising radiation. The purpose of this review is to explore the literature to establish if LUS is being used to aid the management of patients with CF.

The selected abstracts do however hint at the possibility
that LUS could be used as an alternative imaging modality as it does not expose the patient to ionising radiation.
The abstracts indicate that this role may prove most useful
in people with moderate to severe lung changes and with acute pathologies such as consolidation rather than for chronic monitoring of bronchiectatic changes.

Approach

A systematic database search was conducted (PubMed, Medline, Embase, CINAHL, AMED and BNI) up until March 2019.

  • Search terms: “chest” or “lung” or “thora*” and “ultraso*” or “sonogra*” and “cystic fibrosis”.
  • Inclusion: Full papers or abstracts published in English. Use of ultrasound to assess lung pleura, parenchyma or diaphragm.
  • Exclusion: Animal or tissue studies.

Outcomes

A total of 360 abstracts were identified in the database search. Following inclusion and exclusion criteria: 5 conference abstracts were selected without a corresponding full article publication. Abstracts ranged in date from 2015 to 2018. Two abstracts compared LUS to CT for lung pathologies such as bronchiectasis, consolidation, pleural effusion, interstitial syndrome, emphysema and pneumothorax. A further two compared LUS to the lung clearance index (LCI) against CT. The final abstract discussed a case report where LUS was used to monitor and guide the recruitment of lung atelectasis during physiotherapy treatments using continuous positive airway pressure and positioning.

The current literature on the use of LUS as an alternative imaging modality to CXR and CT is only just emerging and should be considered very limited. The selected abstracts do however hint at the possibility that LUS could be used as an alternative imaging modality as it does not expose the patient to ionising radiation. It can also be repeated multiple times throughout a treatment session to monitor the effectiveness of an intervention by both medical and physiotherapy clinicians alike. The abstracts indicate that this role may prove most useful in people with moderate to severe lung changes and with acute pathologies such as consolidation rather than for chronic monitoring of bronchiectatic changes. There remains a significant amount of work to be done before LUS becomes a routine part of the CF management strategy.

Implications

Lung ultrasound could be used to reduce exposure to ionising radiation in patients with CF. Lung ultrasound could also be used to guide medical and physiotherapy treatment interventions and monitor their effectiveness.

Additional notes

This work was presented at Physiotherapy UK 2019