- Email: [email protected]
IPD2.01 A pulmonary rehabilitation program to increase adherence to airway clearance techniques for children and adults with cystic fibrosis
S58
Interactive Poster Discussion Sessions / Journal of Cystic Fibrosis 16S1 (2017) S1–S62
of antifungal therapy in CF is unknown. We retrospectively reviewed the outcomes and tolerability of antifungal therapy in adults with CF. Methods: Patients receiving antifungal therapy at our centre from September 2006 to September 2016 were identified. Data were collected from hospital notes and electronic records. Results: 21 patients (12 male, 9 female) received a total of 41 courses of antifungal therapy. Indication for treatment was: ABPA n = 13 (61.9%), Aspergillus bronchitis n = 6 (28.6%), Aspergillus sensitisation n = 1 (4.8%) and Penicillium sp. infection n = 1 (4.8%). 20/21 patients (95%) had ≥1 sputum positive for fungi prior to antifungals treatment. Within the ABPA group, 1 patient also had co-infection with Rasamsonia sp. and Exophiala sp while another also isolated Scedosporium sp. Therapy was itraconazole only n = 14; itraconazole followed by voriconazole n = 6; itraconazole, amphotericin B, caspofungin and voriconazole sequentially n = 1. Median length of treatment with itraconazole was 327 days (range 31–1,897). 2 patients stopped itraconazole treatment before three months due to alopecia and abdominal pain. Median length of treatment with voriconazole was 89 days (range 31–841). 1 patient stopped voriconazole due to deranged liver function. 12/13 patients with ABPA received oral prednisolone prior to antifungals. Mean total IgE at start of antifungals was 1419.6 ku/L (SD 1714.8 ku/L) and 705.4 ku/L (SD 843.4 ku/L) at 3 months ( p = 0.003). Mean Aspergillusspecific IgE fell from 29.1 ku/L (SD 27.5 ku/L) to 21.6 kuA/L (SD 19.6 ku/L) at 3 months ( p = 0.008). Mean Aspergillus precipitins were 3.6 lines (SD 1.9) at baseline and 3.3 lines (SD 2.0) at 3 months ( p = 0.12). Conclusion: Antifungals were well tolerated and associated with improvements in Aspergillus serology. Prospective studies of antifungals in CF are needed.
Understanding the challenge of adhering to crucial therapies: mission possible? IPD2.01 A pulmonary rehabilitation program to increase adherence to airway clearance techniques for children and adults with cystic fibrosis M.E. Martínez Rodríguez1,2, L. Suarez Cortina3, L. Máiz Carro4, M. Ruiz-de-Valbuena5, L. Jimenez Cosmes6. 1Cystic Fibrosis Unit of the Hospital Universitario Ramón y Cajal, IRYCIS, Department of Physical Medicine and Rehabilitation, Madrid, Spain; 2University of Alcalá, Department of Medicine and Medical Specialties, Alcalá de Henares, Spain; 3Cystic Fibrosis Unit of the Hospital Universitario Ramón y Cajal, IRYCIS, Department of Pediatrics, Madrid, Spain; 4Cystic Fibrosis Unit of the Hospital Universitario Ramón y Cajal, IRYCIS, Department of Respiratory Diseases, Madrid, Spain; 5 Hospital Universitario La Paz, Pediatrics Pneumology Department, Madrid, Spain; 6Hospital Universitario Ramón y Cajal, Department of Physical Medicine and Rehabilitation, Madrid, Spain Objectives: The primary objective of this study was to assess a pulmonary rehabilitation program to increase adherence to airway clearance techniques (ACT) for children and adults with cystic fibrosis. The secondary objectives of the study were to assess a pulmonary rehabilitation program to reduce the frequency of pulmonary exacerbation, antibiotherapy and increase of the pulmonary function and importance given to different types of ACT. Methods: A multicentre, prospective, controlled trial was conducted between March 2011 and December 2012 with a follow-up period of 12 months. A sample of 78 outpatients was assigned into two groups. Patients from intervention group participated in a pulmonary rehabilitation program whereas the control group received chest physiotherapy. Through the year it was stablished that patients would make 6 visits. The program was carry out individually at the medical consultation of the Physical Medical and Rehabilitation MD at the 4, 12 and 36 weeks at the same time their medical checkup. Adherence was assessed via self-administered questionnaire. A computerized spirometer was drowned on for pulmonary function testing. We also analyzed others clinical variables. Results: 78 patients were recruited. 11 patients withdrew from study prior to commencing the intervention. 67 patients were assigned into two
2 groups: intervention group (n = 31; 46.3%) and control group (n = 36; 53,7%). The intervention group increased significantly the percentage of prescribed daily ACT performed as well as the importance given to different types of ACT and patient’s perception compliance. The study found a significant reduction in acute pulmonary exacerbations and antibiotic consumption in the intervention group compared to the control group. The increased of lung function was not significant. Conclusion: Pulmonary rehabilitation program increased adherence to airway clearance techniques and reduce acute pulmonary exacerbations and antibiotic consumption. IPD2.02 Sustaining adherence to colistimethate sodium (Colobreathe®) through a physiotherapist-supervised program (PsP) at home S. Gambazza1, M. Barbisan2, P. Buonpensiero3, A. Orenti4, A. Brivio1, Fisiobrì: A. Bellofiore, S. Buonaurio, F. Carta, F. Collini, G. Di Giandomenico, A. Di Pasqua, B. Giacomodonato, F. Grisorio, G. Mamprin. 1Fondazione IRCCS Ca” Granda, Ospedale Maggiore Policlinico, UOC Fibrosi Cistica Pediatrica, Milan, Italy; 2Ospedale S. Maria di Ca” Foncello, UOS Fibrosi Cistica, Treviso, Italy; 3Università “Federico II”, Dipartimento di Scienze Mediche Traslazionali, Centro Regionale Pediatrico di Rifermento per la Fibrosi Cistica, Napoli, Italy; 4 Università degli Studi di Milano, Dipartimento di Scienze Cliniche e di Comunità, Laboratorio di Statistica Medica, Epidemiologia e Biometria (G.A. Maccacaro), Milan, Italy Background: Inhaled antibiotics are an important therapeutic option, with an impact on quality of life and survival in Cystic Fibrosis (CF); however the therapeutic burden might compromise adherence to treatment. Objectives: To compare clinical outcomes of patients adhering to PsP and those who were just on Colobreathe®(C). Methods: Home visits supported by Domedica S.r.l. and delivered by respiratory physiotherapists to patients taking Colobreathe® were offered to sustain adherence. The study was conducted in eight CF Italian centres. Regression models were used to evaluate the variation at 6 and 12 months of the number of courses of antibiotics, the number of clinic visits and FEV1. Patient satisfaction was assessed through a questionnaire. Data are reported as mean(sd). Results: 196 patients received Colobreathe®,112 joined PsP. Age (P = 0.104) and FEV1 (P = 0.409) were similar among groups. Oral or i.v. antibiotic cycles decreased over time: between T6-T0 −1.0 (95% CI: −1.3, −0.7; P < 0.01) and between T12-T0 −1.1 (95% CI: −1.4, −0.8; P < 0.01). The number of clinic visits decreased between T0-T6 −2.5 (95% CI: −2.8, −2.3; P < 0.01) and T12-T0 −2.6 (95% CI: −2.9, −2.3; P < 0.01). FEV1 declined between T6-T0 −2.4 (95% CI: −4.3, −0.5; P = 0.01) and between T12-T0 −2.0 (95% CI: −4.0, 0.1; P = 0.06). These changes did not differ between groups but PsP showed a reduction in FEV1% between T0 and T12 lower than C (−1.0 vs −3.3; P = 0.26). The 72.1% of respondents claimed that physiotherapist helped to improve drug inhalation and 75.6% that their physiotherapy session improved. Conclusion: The lower number of clinic visits and antibiotics, despite the expected decline in lung function, less pronounced in the group followed at home, deserves attention for further considerations that could include an evaluation of the impact of any home supervision on health costs. IPD2.03 Fostering adherence to help exacerbation reduction (FATHER) – tool for health coaching in cystic fibrosis C. Landon1, R. Turner1. 1Pediatric Diagnostic Center, Ventura, United States Treatment burden is significant, poor adherence well-documented, and loss of lung function with exacerbation irretrievable. Motivational interviewing with health coaching has proven to be effective in promoting adherence to treatment guidelines. Patient engagement with the system is key to success. This pilot study establishes the feasibility and acceptability of a Motivational Interviewing coaching augmented by blue tooth-enabled medication delivery device (eTrack™) of Cayston to integrate current
Interactive Poster Discussion Sessions / Journal of Cystic Fibrosis 16S1 (2017) S1–S62
of antifungal therapy in CF is unknown. We retrospectively reviewed the outcomes and tolerability of antifungal therapy in adults with CF. Methods: Patients receiving antifungal therapy at our centre from September 2006 to September 2016 were identified. Data were collected from hospital notes and electronic records. Results: 21 patients (12 male, 9 female) received a total of 41 courses of antifungal therapy. Indication for treatment was: ABPA n = 13 (61.9%), Aspergillus bronchitis n = 6 (28.6%), Aspergillus sensitisation n = 1 (4.8%) and Penicillium sp. infection n = 1 (4.8%). 20/21 patients (95%) had ≥1 sputum positive for fungi prior to antifungals treatment. Within the ABPA group, 1 patient also had co-infection with Rasamsonia sp. and Exophiala sp while another also isolated Scedosporium sp. Therapy was itraconazole only n = 14; itraconazole followed by voriconazole n = 6; itraconazole, amphotericin B, caspofungin and voriconazole sequentially n = 1. Median length of treatment with itraconazole was 327 days (range 31–1,897). 2 patients stopped itraconazole treatment before three months due to alopecia and abdominal pain. Median length of treatment with voriconazole was 89 days (range 31–841). 1 patient stopped voriconazole due to deranged liver function. 12/13 patients with ABPA received oral prednisolone prior to antifungals. Mean total IgE at start of antifungals was 1419.6 ku/L (SD 1714.8 ku/L) and 705.4 ku/L (SD 843.4 ku/L) at 3 months ( p = 0.003). Mean Aspergillusspecific IgE fell from 29.1 ku/L (SD 27.5 ku/L) to 21.6 kuA/L (SD 19.6 ku/L) at 3 months ( p = 0.008). Mean Aspergillus precipitins were 3.6 lines (SD 1.9) at baseline and 3.3 lines (SD 2.0) at 3 months ( p = 0.12). Conclusion: Antifungals were well tolerated and associated with improvements in Aspergillus serology. Prospective studies of antifungals in CF are needed.
Understanding the challenge of adhering to crucial therapies: mission possible? IPD2.01 A pulmonary rehabilitation program to increase adherence to airway clearance techniques for children and adults with cystic fibrosis M.E. Martínez Rodríguez1,2, L. Suarez Cortina3, L. Máiz Carro4, M. Ruiz-de-Valbuena5, L. Jimenez Cosmes6. 1Cystic Fibrosis Unit of the Hospital Universitario Ramón y Cajal, IRYCIS, Department of Physical Medicine and Rehabilitation, Madrid, Spain; 2University of Alcalá, Department of Medicine and Medical Specialties, Alcalá de Henares, Spain; 3Cystic Fibrosis Unit of the Hospital Universitario Ramón y Cajal, IRYCIS, Department of Pediatrics, Madrid, Spain; 4Cystic Fibrosis Unit of the Hospital Universitario Ramón y Cajal, IRYCIS, Department of Respiratory Diseases, Madrid, Spain; 5 Hospital Universitario La Paz, Pediatrics Pneumology Department, Madrid, Spain; 6Hospital Universitario Ramón y Cajal, Department of Physical Medicine and Rehabilitation, Madrid, Spain Objectives: The primary objective of this study was to assess a pulmonary rehabilitation program to increase adherence to airway clearance techniques (ACT) for children and adults with cystic fibrosis. The secondary objectives of the study were to assess a pulmonary rehabilitation program to reduce the frequency of pulmonary exacerbation, antibiotherapy and increase of the pulmonary function and importance given to different types of ACT. Methods: A multicentre, prospective, controlled trial was conducted between March 2011 and December 2012 with a follow-up period of 12 months. A sample of 78 outpatients was assigned into two groups. Patients from intervention group participated in a pulmonary rehabilitation program whereas the control group received chest physiotherapy. Through the year it was stablished that patients would make 6 visits. The program was carry out individually at the medical consultation of the Physical Medical and Rehabilitation MD at the 4, 12 and 36 weeks at the same time their medical checkup. Adherence was assessed via self-administered questionnaire. A computerized spirometer was drowned on for pulmonary function testing. We also analyzed others clinical variables. Results: 78 patients were recruited. 11 patients withdrew from study prior to commencing the intervention. 67 patients were assigned into two
2 groups: intervention group (n = 31; 46.3%) and control group (n = 36; 53,7%). The intervention group increased significantly the percentage of prescribed daily ACT performed as well as the importance given to different types of ACT and patient’s perception compliance. The study found a significant reduction in acute pulmonary exacerbations and antibiotic consumption in the intervention group compared to the control group. The increased of lung function was not significant. Conclusion: Pulmonary rehabilitation program increased adherence to airway clearance techniques and reduce acute pulmonary exacerbations and antibiotic consumption. IPD2.02 Sustaining adherence to colistimethate sodium (Colobreathe®) through a physiotherapist-supervised program (PsP) at home S. Gambazza1, M. Barbisan2, P. Buonpensiero3, A. Orenti4, A. Brivio1, Fisiobrì: A. Bellofiore, S. Buonaurio, F. Carta, F. Collini, G. Di Giandomenico, A. Di Pasqua, B. Giacomodonato, F. Grisorio, G. Mamprin. 1Fondazione IRCCS Ca” Granda, Ospedale Maggiore Policlinico, UOC Fibrosi Cistica Pediatrica, Milan, Italy; 2Ospedale S. Maria di Ca” Foncello, UOS Fibrosi Cistica, Treviso, Italy; 3Università “Federico II”, Dipartimento di Scienze Mediche Traslazionali, Centro Regionale Pediatrico di Rifermento per la Fibrosi Cistica, Napoli, Italy; 4 Università degli Studi di Milano, Dipartimento di Scienze Cliniche e di Comunità, Laboratorio di Statistica Medica, Epidemiologia e Biometria (G.A. Maccacaro), Milan, Italy Background: Inhaled antibiotics are an important therapeutic option, with an impact on quality of life and survival in Cystic Fibrosis (CF); however the therapeutic burden might compromise adherence to treatment. Objectives: To compare clinical outcomes of patients adhering to PsP and those who were just on Colobreathe®(C). Methods: Home visits supported by Domedica S.r.l. and delivered by respiratory physiotherapists to patients taking Colobreathe® were offered to sustain adherence. The study was conducted in eight CF Italian centres. Regression models were used to evaluate the variation at 6 and 12 months of the number of courses of antibiotics, the number of clinic visits and FEV1. Patient satisfaction was assessed through a questionnaire. Data are reported as mean(sd). Results: 196 patients received Colobreathe®,112 joined PsP. Age (P = 0.104) and FEV1 (P = 0.409) were similar among groups. Oral or i.v. antibiotic cycles decreased over time: between T6-T0 −1.0 (95% CI: −1.3, −0.7; P < 0.01) and between T12-T0 −1.1 (95% CI: −1.4, −0.8; P < 0.01). The number of clinic visits decreased between T0-T6 −2.5 (95% CI: −2.8, −2.3; P < 0.01) and T12-T0 −2.6 (95% CI: −2.9, −2.3; P < 0.01). FEV1 declined between T6-T0 −2.4 (95% CI: −4.3, −0.5; P = 0.01) and between T12-T0 −2.0 (95% CI: −4.0, 0.1; P = 0.06). These changes did not differ between groups but PsP showed a reduction in FEV1% between T0 and T12 lower than C (−1.0 vs −3.3; P = 0.26). The 72.1% of respondents claimed that physiotherapist helped to improve drug inhalation and 75.6% that their physiotherapy session improved. Conclusion: The lower number of clinic visits and antibiotics, despite the expected decline in lung function, less pronounced in the group followed at home, deserves attention for further considerations that could include an evaluation of the impact of any home supervision on health costs. IPD2.03 Fostering adherence to help exacerbation reduction (FATHER) – tool for health coaching in cystic fibrosis C. Landon1, R. Turner1. 1Pediatric Diagnostic Center, Ventura, United States Treatment burden is significant, poor adherence well-documented, and loss of lung function with exacerbation irretrievable. Motivational interviewing with health coaching has proven to be effective in promoting adherence to treatment guidelines. Patient engagement with the system is key to success. This pilot study establishes the feasibility and acceptability of a Motivational Interviewing coaching augmented by blue tooth-enabled medication delivery device (eTrack™) of Cayston to integrate current