Flu wave’s hidden cost on people with cystic fibrosis

People with cystic fibrosis (CF) are uniquely vulnerable to the flu wave currently ripping through the UK, a clinical researcher from The University of Manchester has warned.

Professor Alex Horsley made the comments following last week’s news that flu cases jumped 55 % in a week with an average of 2,660 patients a day being treated in an NHS hospital bed - the highest ever for this time of year.

In the North West, the most recent figures show a 36.6 % increase in the number of people hospitalized with flu.

NHS England is also urging eligible populations, including those people with CF, to come forward for flu vaccinations as soon as they can avoid becoming seriously ill.

Patients with CF often have chronic infection and cough, usually controlled with nebulizer medications to help them clear mucus in the lungs and antibiotics to control infection.

However influenza can sometimes have devastating consequences from escalating lung infections and breathlessness, resulting in admission to hospital.

Professor Horsley, a leading expert in cystic fibrosis, is a Professor at The University of Manchester respiratory consultant at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust and Medical Director of the National Institute for Health and Care Research (NIHR) Manchester Clinical Research Facility at Wythenshawe Hospital.

He said: “CF is an inherited condition, and one of the most common life-limiting genetic conditions in the UK, affecting around 11000 people.

“It primarily affects the lungs, though also has important impacts on the pancreas, causing malnutrition and diabetes, and on the gut and liver.

“For people with CF, the winter wave of flu and flu-like illnesses can be especially challenging and damaging.

“That is why it is so important people take care at this time of year, make sure they have had their flu vaccine, and do their best to avoid being exposed to those with viral symptoms.

“In our cystic fibrosis centre at Wythenshawe Hospital, we run emergency reviews every weekday to see people acutely unwell and start treatment as soon as possible.

“But we’re also researching better ways to help people with CF and are leading a new study to understand and prevent it.”

Previous work in Manchester has highlighted the potential impact of viral infections on people with CF, and shown how these may relate to increased admissions and need for IV antibiotics.

However the new study, part of a multi-million pound Research Innovation Hub funded by the CF Trust, is now hoping to define exactly which viruses are responsible for the worst infections in people with CF, and how they do this.

The researchers plan to use the information to discover and trial new treatments to prevent exacerbations. This study, called “CF-Tracker”, is based at the University of Manchester but involves researchers and clinical teams across the UK.

Recent advances in CF therapies include a group of drugs called CFTR modulators, and Manchester led the latest clinical trials of these therapies.

Since the CFTR modulators, people with CF have got used to much better health and reduced lung symptoms.

But up to a quarter of CF adults still end up requiring IV antibiotics each year, and some require several courses. These are serious events, not just because they disrupt work and home life but because they are associated with faster decline in health and survival.”

Horsley, Professor, The University of Manchester

Laura’s Beattie’s story

She said: “My cystic fibrosis made things very difficult for me when I contracted the flu in 2022. It completely floored me and I ended up going to A&E because my breathing was so laboured, my oxygen saturations were dropping, and my heart rate was really high.

“It was doubly bad because I spent the Christmas period on 24/7 oxygen, IV antibiotics throughout the day, and having intravenous infusions continually. It took a long time to get back to any kind of normality, and it affected me for months afterwards.

“Earlier this year, I was admitted again for another virus. This admission ended up being one of the longest I’ve ever had. Even now, at home, I’m still recovering, and I’m nowhere near my usual self.”

“It’s incredibly frustrating when you don’t know exactly what has triggered an exacerbation, and even more frustrating not knowing how it’s going to affect you while you’re going through it or how long the recovery will take.

“Viral infections like flu, or a CF exacerbation or a CF exacerbation triggered by a virus, are completely unpredictable.

“You never know how hard they will hit or how much they might change things long-term. That uncertainty is really scary, and the impact on how your CF progresses can be huge.”