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Adult Guide to CF

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Adult Guide to CF Adult Guide to Cystic Fibrosis INTRODUCTION Welcome to the Adult Guide to Cystic Fibrosis — whether you’re an adult, a teen preparing to transition to an Adult CF Program, a parent of a child looking ahead, or a friend or relative of someone with CF, you’ll find answers and insights here. We asked medical experts and others living with CF to share the very best information, then gathered more from adult CF programs and the Cystic Fibrosis Foundation. The result: pages packed with answers, tips, tricks, and tons of resources related to your health and well-being. But we didn’t stop there. Being an adult with CF brings on some pretty distinct challenges. Relationships, travel, and social support — we cover all these topics too. Let us know how helpful you found this resource and if you have ideas on how to make it more useful. Email [email protected] or complete this short survey. CFF.ORG ADULT GUIDE TO CYSTIC FIBROSIS 2 The Adult Guide is an easy reference for you to browse topics of interest. The information is intended to help you manage cystic fibrosis in partnership with yourCF care team. It is not intended to replace treatment advice from medical professionals. If you have questions about anything you have read here, your CF care team can answer those questions or discuss any concerns specific to your individual health care needs. PAGE Basics of Lung Care ................................................................................ 5 Sinusitis and CF ..................................................................................... 12 Nontuberculous Mycobacteria (NTM) ................................................. 17 Lung Transplantation ............................................................................ 22 Basics of the Digestive Tract ................................................................ 29 Distal Intestinal Obstructive Syndrome (DIOS) ................................... 40 Gastroesophageal Reflux in CF ............................................................ 46 Improving Nutrition With Tube Feedings ............................................ 51 CF-Related Diabetes (CFRD) ................................................................ 60 Basics of Infection Control ................................................................... 70 Vascular Access Devices (a.k.a. PICCs/Ports) ....................................... 82 Anxiety and Depression ....................................................................... 88 Basics of CF and Male Infertility ........................................................... 98 Birth Control for Women With CF ..................................................... 103 Pregnancy in CF .................................................................................. 112 CFF.ORG ADULT GUIDE TO CYSTIC FIBROSIS 3 Menopause in CF ............................................................................... 118 Day-to-Day Time Management .........................................................124 Eating on the Go ................................................................................133 Exercise With CF ................................................................................148 Having a Fabulous Social Life ............................................................. 161 Traveling With CF ...............................................................................168 Parenting as an Adult With CF ...........................................................175 Finding Community Support .............................................................182 Managing Home Care ........................................................................190 Changing Care Centers ......................................................................198 Participating in CF Clinical Trials ........................................................202 CFF.ORG ADULT GUIDE TO CYSTIC FIBROSIS 4 Basics of Lung Care Although cystic fibrosis affects many parts of the body, for most people with CF it’s the lung disease that causes the most problems. Sometimes it’s hard to give our lungs a lot of love, especially when they may seem more like mucus makers than the body’s essential gear for breathing. But with the right kind of attention from you — and the help of medications and your CF care team — your lungs can do the vital work they were meant to do. Giving you the facts, tips, and resources to make that happen is what this guide to lung care is all about. IN THIS SECTION: Learn about your lungs to help you keep them clear. Work with your CF team to keep your lung function as high as possible. Use the right therapies and airway clearance techniques so you can breathe easier. Manage your time so you can do all the other things you need or want to do. Get help when you are sick — it can save your life, especially when you have exacerbations. CFF.ORG ADULT GUIDE TO CYSTIC FIBROSIS 5 Basics of Lung Care LEARN ABOUT YOUR LUNGS Cystic fibrosis is caused by abnormalities in a protein called CFTR (cystic fibrosis transmembrane conductance regulator). This protein normally ends up on the surface of cells in the lungs — and in the pancreas and other organs — where it helps with the basic “housecleaning” of the cells. When CFTR works correctly it helps move chloride, water, and other small molecules out of the cells and onto the surface of the airways. But with CF, this protein doesn’t get to the cell surface, or it’s there but doesn’t function properly. The chloride, water, and other molecules do not move into the airways and the cells cannot do their normal microscopic housecleaning. Without the body’s typical cleaning process, the airways get into a cycle of inflammation (swelling) and infection. This causes mucus and bacteria to build up in the lungs of people with CF. Monitoring and minimizing this buildup of mucus and bacteria are two key jobs of your CF care team. For more information, read Work With Your CF Team. BEYOND THE BASICS The key protein in CF is CFTR. The genetic “blueprint” for CFTR, and for all proteins in the body, lies in the DNA code that determines our body’s basic makeup. In people with CF, the instructions for the CF gene have been altered, creating a defective gene. That in turn produces a faulty CFTR protein. More than 2,000 mutations in the CF gene have been identified. The The relationship relationship between a person’s CF between a person’s CF mutation (“genotype”) and the way that mutation (“genotype”) the disease affects that person’s body (“phenotype”) is complex. and the way that the disease affects In some mutations, no CFTR protein is that person’s body made at all. In others, CFTR is made but then gets “stuck” and doesn’t move (“phenotype”) from the center of the cell to the surface. is complex. Some mutations make the protein and it gets to the cell surface, but it works too weakly to do its job. CFF.ORG ADULT GUIDE TO CYSTIC FIBROSIS 6 Basics of Lung Care Different therapies may be useful for different cystic fibrosis mutations. If you have not been “genotyped” or tested to find out which CF mutation or mutations you have, talk about this with your CF care team. WORK WITH YOUR CF TEAM Monitoring and minimizing the buildup of mucus and bacteria in your lungs are two of the key jobs of your CF care team at your care center. When you come for a check-up, your CF care team will likely have you take pulmonary function tests (PFTs). They will ask you about your breathing, coughing, and the amount of sputum you are making. They’ll also ask for a sample of your sputum, which is tested to see what kinds of bacteria are growing and Center for Cystic Fibrosis at Keck Hospital of USC Keck Medical which antibiotics might fight them. Center of USC This is called a “sputum culture.” Your PFT results will probably look like a sea of numbers and maybe a line graph. The most important PFT is the FEV1, which helps to measure lung function. Your FEV1 is the amount of air you can blow out in the first second of a forceful exhalation. Your care team may seem totally obsessed with keeping your FEV1 as high as possible. Well, that’s their job. Keeping your FEV1 as high as possible is also the job of your meds or pulmonary therapies. See Use the Right Therapies for more detail on current therapies, as well as some potential new ones. ADDITIONAL RESOURCES › Learn how adults with CF can be full members of their CF care teams. USE THE RIGHT THERAPIES Right now, there are three categories of pulmonary therapies for CF. One helps clear sputum out of your lungs; another helps control bacteria; and the third reduces inflammation. CFF.ORG ADULT GUIDE TO CYSTIC FIBROSIS 7 Basics of Lung Care CLEARING OUT SPUTUM A powerful cough is your lungs’ way of getting rid of sputum. The less sputum, the less your airways get plugged, the fewer bacteria grow, and the better you’ll breathe. But your regular cough often needs a boost, since CF sputum is thick and sticky and there’s usually a lot of it. Some therapies “jiggle” the sputum, making it easier to cough out. These are called airway clearance techniques (ACTs). They include manual chest physiotherapy (CPT), when another person claps on your chest with their hands; vibrating devices and vests; devices that create a fluttering pressure as you blow through them; and good old-fashioned exercise. All of these ACTs work like hitting a ketchup bottle to get ketchup out. Of course, you can also thin ketchup. Other clearing therapies thin the sputum so it’s easier to cough out. They include DNase (Pulmozyme®) and hypertonic saline.
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