Improved outcomes in cystic fibrosis using modified R e-E ducation of A irway C learance T echnique (REACT) programme

Abstract

Background and objectives Cystic fibrosis (CF) is known to reduce lung function as measured by per cent predicted for the forced expiratory volume in the first second (ppFEV 1) over time. Our paediatric CF programme demonstrated significant gaps in benchmarked ppFEV 1 predicted compared with the national median. Our objective was to assess whether the implementation of a modified Re-Education of Airway Clearance Techniques (REACT) programme could lead to an improvement in lung function as measured by ppFEV 1. Methods This 2-year prospective quality improvement study at Lurie Children's CF Center for children aged >6 years used improvement methodology to implement a modified REACT programme. Outcome measures were assessed for our entire programme via the CF Foundation Patient Registry (CFFPR) and statistical process control. Comparisons were also made before and after REACT for outcome measures. Results By the end of implementation, monthly participation rate achieved 100%. Using CFFPR data and SPC, median ppFEV 1 increased by 3.9%, whereas only body mass index (BMI) as a secondary outcome increased. Comparison of pre and post REACT showed improvements in average ppFEV 1 (95% vs 96%, p<0.0001), FEF 25%-75% (82% vs 83%, p=0.0590), rate of ppFEV1 decline (+2% vs-4%, p=0.0262) and BMI percentile (57% vs 60%, p<0.0001). Conclusions Implementation of a modified REACT at Lurie Children's paediatric CF programme led to an increase in ppFEV 1, FEF 25%-75% and BMI percentile.