J Pediatr Infect Dis 2023; 18(05): 232-239
DOI: 10.1055/s-0043-1769902
Original Article

An Evaluation of the Risk Factors and Respiratory Function Test Change of Children with Cystic Fibrosis Who Contracted COVID-19 Infection

1   Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Türkiye
Handan Duman Şenol
2   Pediatric Allery and İmmünology, Ege University Faculty of Medicine, İzmir, Türkiye
Meral Barlık
1   Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Türkiye
Fevziye Çoksuer
1   Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Türkiye
Bahar Girgin Dindar
1   Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Türkiye
Esen Demir
1   Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Türkiye
Figen Gülen
1   Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Türkiye
› Author Affiliations


Objective Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a global pandemic in March 2020, with millions of infected cases worldwide. Although the course is usually mild in the pediatric age group, there are unknown factors in patients with chronic lung diseases. The aim of this study was to determine the demographic characteristics and the clinical course of patients with cystic fibrosis who contracted COVID-19 infection.

Methods A total of 128 patients with cystic fibrosis who were under follow-up in our clinic were separated into two groups: those who had been infected with COVID-19 and those who had not. The COVID-19-positive patients were then grouped as those who were hospitalized and those treated as outpatients. In the COVID-19 group, the spirometry values of the patients before the infection were compared with those measured at 3 and 6 months after the infection.

Results The COVID-19 group comprised 34 (25.6%) cystic fibrosis patients with a mean age of 108.2 ± 60.8 months who contracted COVID-19 between April 2020 and October 2022. The rates of chronic bacterial colonization and allergic bronchopulmonary aspergillosis were significantly higher in the COVID-19 group (p = 0.001 and 0.005). Eight of the 34 patients were hospitalized, and 26 were isolated at home. Five patients required oxygen, and the forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) values were lower.

Conclusion A severe course of COVID-19 was not seen in any of the cystic fibrosis patients. A greater number of patients with chronic respiratory tract bacterial colonization and allergic bronchopulmonary aspergillosis were hospitalized.


The study was approved by Ege University Clinical Research Ethics Committee and financially supported by Ege University Office of Scientific Research Projects (Project No: 22-7T/32).

Publication History

Received: 23 December 2022

Accepted: 02 May 2023

Article published online:
12 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
  • 2 Wu F, Zhao S, Yu B. et al. A new coronavirus associated with human respiratory disease in China. Nature 2020; 579 (7798): 265-269
  • 3 Nguyen HL, Lan PD, Thai NQ, Nissley DA, O'Brien EP, Li MS. Does SARS-CoV-2 bind to human ACE2 more strongly than does SARS-CoV?. J Phys Chem B 2020; 124 (34) 7336-7347
  • 4 Bunyavanich S, Do A, Vicencio A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. JAMA 2020; 323 (23) 2427-2429
  • 5 Howard-Jones AR, Burgner DP, Crawford NW. et al. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health 2022; 58 (01) 46-53
  • 6 Viner RM, Ward JL, Hudson LD. et al. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch Dis Child 2020; 106: 802-807
  • 7 Götzinger F, Santiago-García B, Noguera-Julián A. et al; ptbnet COVID-19 Study Group. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health 2020; 4 (09) 653-661
  • 8 Halpin DMG, Faner R, Sibila O, Badia JR, Agusti A. Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection?. Lancet Respir Med 2020; 8 (05) 436-438
  • 9 Bain R, Cosgriff R, Zampoli M. et al. Clinical characteristics of SARS-CoV-2 infection in children with cystic fibrosis: an international observational study. J Cyst Fibros 2021; 20 (01) 25-30
  • 10 Quanjer PH, Stanojevic S, Cole TJ. et al; ERS Global Lung Function Initiative. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 2012; 40 (06) 1324-1343
  • 11 de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85 (09) 660-667
  • 12 Bhuiyan MU, Stiboy E, Hassan MZ. et al. Epidemiology of COVID-19 infection in young children under five years: a systematic review and meta-analysis. Vaccine 2021; 39 (04) 667-677
  • 13 Lifen Y, Zhen Yuan D, Mengqi D. et al. Suggestions for medical staff from department of pediatrics during the treatment of 2019-nCoV infection/pneumonia. J Nat Med 2020; 51 (02) 77-84
  • 14 Centers for Disease Control and Prevention. Demographic trends of COVID-19 cases and deaths in the US reported to CDC: cases by race/ethnicity; deaths by race/ethnicity; cases by age group; deaths by age group; cases by sex; deaths by sex. Published on December 22, 2020. Accessed April 7, 2022 at: https://stacks.cdc.gov/view/cdc/99332
  • 15 Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int 2021; 41 (01) 19-32
  • 16 Badal S, Thapa Bajgain K, Badal S, Thapa R, Bajgain BB, Santana MJ. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: a systematic review and meta-analysis. J Clin Virol 2021; 135: 104715
  • 17 She J, Liu L, Liu W. COVID-19 epidemic: disease characteristics in children. J Med Virol 2020; 92 (07) 747-754
  • 18 Leung C. Clinical characteristics of COVID-19 in children: are they similar to those of SARS?. Pediatr Pulmonol 2020; 55 (07) 1592-1597
  • 19 Öztürk GK, Beken B, Doğan S, Akar HH. Pulmonary function tests in the follow-up of children with COVID-19. Eur J Pediatr 2022; 181 (07) 2839-2847
  • 20 Ferraro VA, Zanconato S, Carraro S. Impact of COVID-19 in children with chronic lung diseases. Int J Environ Res Public Health 2022; 19 (18) 11483
  • 21 Du H, Dong X, Zhang JJ. et al. Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status. Allergy 2021; 76 (02) 510-532
  • 22 Shi T, Pan J, Katikireddi SV. et al; Public Health Scotland and the EAVE II Collaborators. Risk of COVID-19 hospital admission among children aged 5-17 years with asthma in Scotland: a national incident cohort study. Lancet Respir Med 2022; 10 (02) 191-198
  • 23 Bellino S, Punzo O, Rota MC. et al; COVID-19 WORKING GROUP. COVID-19 disease severity risk factors for pediatric patients in Italy. Pediatrics 2020; 146 (04) e2020009399
  • 24 Moeller A, Thanikkel L, Duijts L. et al. COVID-19 in children with underlying chronic respiratory diseases: survey results from 174 centres. ERJ Open Res 2020; 6 (04) 00409-02020
  • 25 Kosmeri C, Koumpis E, Tsabouri S, Siomou E, Makis A. Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer 2020; 67 (12) e28745
  • 26 Stanton BA, Hampton TH, Ashare A. SARS-CoV-2 (COVID-19) and cystic fibrosis. Am J Physiol Lung Cell Mol Physiol 2020; 319 (03) L408-L415
  • 27 Al Yazidi LS, Al Maskari N, Al Reesi M. Children with cystic fibrosis hospitalised with COVID-19: multicentre experience. J Paediatr Child Health 2021; 57 (05) 767-768