Can a 12-month outreach initiative focussing on physiotherapy and dietary improvement reduce IV-antibiotic requirements in children with moderate-severe CF?
Why is this important?
Airway clearance and exercise are essential components of the physiotherapy management of CF. It is important to carefully monitor children with CF who regularly exercise, as the increased energy demands may impact on body mass index, which is strongly linked with lung function.
What did you do?
The Frequent Flyer Programme was undertaken as a quality improvement initiative within the hospital’s CF Unit between September 2010 and April 2012. The programme, so named because the children enrolled spend so much time in hospital, aimed to reduce the need for IV-antibiotic treatment and to improve their health.
Sixteen children, aged 4-15 years, who had needed more than 40 days of IV-antibiotic treatment in the previous 12 months, were invited to participate. Physiotherapy included a weekly, personal exercise training session and monthly review of airway clearance therapy. In addition, children were encouraged to exercise independently. Dietary management included more regular monitoring of growth, absorption, appetite and intake, as well as nutritional education sessions.
What did you find?
There was a 25% reduction in IV-antibiotic treatment when compared to the previous year. This meant that children were able to spend more time at home and school, experienced less of a dip in their general quality of health, and families reported that their children had an improved quality of life. Fitness levels increased significantly, with children saying they were now able to exercise at the same level or sometimes even higher than their peers. The majority of children on the programme maintained their lung function and growth outcomes. The programme saved approximately £113,570.
What does this mean and reasons for caution?
This programme showed positive benefits in a small group of children. If these results were replicated in other CF units, the implications for cost saving, improvement in health and quality of life are potentially extensive.
INSPIRE-CF is a new randomised controlled trial that aims to evaluate the clinical and economic benefits of a similar programme, in a larger group of children with a wider range of disease severity.