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Cystic fibrosis

Last reviewed: 6 Apr 2025
Last updated: 10 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • positive newborn screen
  • failure to pass meconium
  • failure to thrive
  • voracious appetite
  • wet-sounding cough
  • recurrent infection
  • chronic rhinosinusitis
  • genital abnormalities in males
  • hemoptysis
Full details

Other diagnostic factors

  • malabsorptive stool with steatorrhea
  • digital clubbing
  • gastroesophageal reflux
  • wheeze
  • increased anteroposterior (AP) diameter of the chest
  • history of pancreatitis
  • history of acute appendicitis
  • enlarged liver or spleen
Full details

Risk factors

  • family history of CF
  • known carrier status of both parents
  • ethnicity
Full details

Diagnostic tests

1st tests to order

  • sweat test
  • genetic testing
Full details

Tests to consider

  • sinus imaging
  • deep throat swab
Full details

Treatment algorithm

ACUTE

neonates with meconium ileus/partial distal intestinal obstruction

complete intestinal obstruction or peritonitis

acute respiratory infection

ONGOING

respiratory disease

gastrointestinal disease

Contributors

Authors

Samuel B. Goldfarb, MD

Professor of Pediatrics

Masonic Children's Hospital

University of Minnesota School of Medicine

Minneapolis

MN

Disclosures

SBG declares a personal interest in the Cystic Fibrosis Therapeutic Development Network (TDN) involving multiple CF multicentered studies.

Pi Chun (Jennifer) Cheng, MD, MS

Assistant Professor of Pediatrics

Riley Hospital for Children

Indiana University School of Medicine

Indianapolis

IN

Disclosures

PCC declares that she has no competing interests.

Maureen Banfe Josephson, DO

Assistant Professor of Pediatrics

The Children's Hospital of Philadelphia

Perelman School of Medicine at the University of Pennsylvania

Philadelphia

PA

Disclosures

MBJ declares that she has no competing interests.

Acknowledgements

Dr Samuel B. Goldfarb, Dr Pi Chun (Jennifer) Cheng, and Dr Maureen Banfe Josephson would like to gratefully acknowledge Dr James L. Kreindler, a previous contributor to this topic.

Disclosures

JLK declares that he has no competing interests.

Peer reviewers

Sangeeta M. Bhorade, MD

Associate Professor of Medicine

Medical Director

Lung Transplant Program

University of Chicago Hospitals

Chicago

IL

Disclosures

SMB declares that she has no competing interests.

Alan Smyth, MA, MBBS, MRCP, MD, FRCPCH

Associate Professor & Reader in Child Health

Division of Child Health

University of Nottingham

Queens Medical Centre

Nottingham

UK

Disclosures

AS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Farrell PM, White TB, Ren CL, et al. Diagnosis of cystic fibrosis: consensus guidelines from the Cystic Fibrosis Foundation. J Pediatr. 2017 Feb;181S:S4-15.e1.Full text  Abstract

Mogayzel PJ Jr, Naureckas ET, Robinson KA, et al. Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. Am J Respir Crit Care Med. 2013 Apr 1;187(7):680-9.Full text  Abstract

Flume PA, Robinson KA, O'Sullivan BP, et al; Clinical Practice Guidelines for Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: airway clearance therapies. Respir Care. 2009 Apr;54(4):522-37.Full text  Abstract

Ramos KJ, Smith PJ, McKone EF, et al. Lung transplant referral for individuals with cystic fibrosis: Cystic Fibrosis Foundation consensus guidelines. J Cyst Fibros. 2019 May;18(3):321-33.Full text  Abstract

Kapnadak SG, Dimango E, Hadjiliadis D, et al. Cystic Fibrosis Foundation consensus guidelines for the care of individuals with advanced cystic fibrosis lung disease. J Cyst Fibros. 2020 May;19(3):344-54.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Guidelines

    • Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
    • Models of palliative care delivery for individuals with cystic fibrosis
    More Guidelines
  • Patient information

    Cystic fibrosis: what is it?

    Cystic fibrosis: what treatments work?

    More Patient information
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