Clinical outcomes, including lung function, BMI and hospitalisations for cystic fibrosis (CF)-related issues improved in the first 12 months of the COVID-19 pandemic in Australia, research shows.
The findings suggest population-wide infection control measures including the shift to telehealth were beneficial for people with CF, according to respiratory physicians in NSW.
A retrospective cohort study using data from children and adults in the Australian Cystic Fibrosis Data Registry (ACFDR), compared clinical outcomes for time periods before and after the onset of the pandemic.
The study of 3,662 people with CF found FEV1 % pred improved in the period after the index date – nominally 16 March 2020 – compared to the months prior.
“In the 5-12-year age group and the ≥18 age group, there was a decline in FEV1 % pred trends in the 24 months prior to the index date, whereas in the 12 months following the index date there was an improvement. In the 12-to-17-year age group, the slope in the 24 months before the index date was positive and became more positive in the 12 months following the index date,” the study authors said.
Published in the Journal of Cystic Fibrosis [link here], the study found BMI before the pandemic onset was stable, followed by a small, statistically significant upward trend in the 12 months following the index date.
As well, there was a statistically significant reduction in the number of people with CF being hospitalised in the 12 months following the index date compared to the 12 months prior (p < 0.001).
There was also a 26% reduction in courses of intravenous antibiotics administered in the post-index period (p<0.001).
The pandemic saw an increase in the proportion of telehealth consultations from 8% before the index date to 47% after COVID-19 arrived.
Patients were also seen more frequently in the post-index period with an increase in the total number of outpatient clinical reviews as well as an increase in average outpatient reviews per person from a median of 4 to 5 per patient (p < 0.001).
“This study has demonstrated that the COVID-19 pandemic forced a change in the CF model of clinical care delivery,” it said.
The study noted that the finding of reduced respiratory exacerbations during the pandemic was consistent with other populations such as adults with COPD.
“In children with asthma, there has also been an observed reduction in upper respiratory tract infections, presentations to emergency departments and hospitalisations.”
“A potential explanation for a reduction in pulmonary exacerbations shown in people with CF and other respiratory diseases is the reduction in exposure to respiratory viruses, not just SARS-CoV2, during the period of pandemic restrictions.”
“An additional finding in the current study which may have contributed to improved clinical outcomes was the overall significant increase in number of clinical reviews undertaken,” it said.
They said while the increased use of telehealth was likely to persist, “potential risks and barriers to telehealth, such as access to technology, difficulties with performing assessments such as spirometry, microbiological monitoring and mental health screening have also been identified” and warrant consideration.