The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

INDIVIDUALIZED SELF-MANAGEMENT ACTION PLAN USING A STEPWISE APPROACH TO AIRWAY CLEARANCE TECHNIQUES AND HOME SPIROMETRY MONITORING IN CYSTIC FIBROSIS. STEP-UP TO BETTER BREATHING (SUBB).

Michael Cantine1, Paula Lomas2, Elissa Cohen-Engel2, Carol Cahill2, Rebecca Griffith2, Stanley Fiel2, Arthur Atlas3, Rami Bustami4; 1Respiratory Care, Morristown Medical Centner, Morristown, NJ; 2Department of Medicine, Morristown Medical Center, Morristown, NJ; 3Goryeb Children’s Hospital, Morristown Medical Center, Morristown, NJ; 4Department of Grants and Research, Atlantic Health, Morristown, NJ

Background: Some chronic disease states use monitoring devices to help manage the disease process: one example would be a glucometer for daily glucose measurement. In cystic fibrosis (CF), the forced expiratory volume in the first second (FEV1) is an important value in the management of CF. Treatment and disease management decisions are made as a result of these values. Individuals with CF do not know their FEV1 value between center visits or how it is impacted by exacerbation or airway clearance (ACT) activities. Objective: This study will provide FEV1 and exacerbation data to the individual on a daily basis. This information provides a foundation to make daily, self-management decisions on how to plan the course of the day in terms of stepping-up ACT and treatment needs. Method: This is an observational study performed over a 2 to 3 month time period between center visits. 44 patients were given a PIKO 6 spirometer as well as exacerbation score (based on the Akron Children’s Hospital exacerbation score). The patients were instructed to perform and measure FEV1 daily as well as a self-assessment of exacerbation. These values were documented on their daily log. As a result, if the patient noted a decline in FEV1 or a rise in their exacerbation score, they would step-up their ACT activities. If their exacerbation score reached 3 on a 10 point scale, for more than 3 days or reached 5 on the 10 point scale, they were instructed to call the center and report their data. Results: Pre and post Cystic Fibrosis Quality of Life revised (CFQ-R) scores, exacerbation scores and FEV1 were measured. A post-study questionnaire was performed. The pre and post CFQ-R overall was: 73.34 pre study, 72.01 post study which does not demonstrate a significant reduction in CFQ-R. The mean FEV1 pre study was 2.39 L and post was 2.44 L. No significant change was noted. The mean exacerbation score pre study was 2.66 and post study was 1.87 on a 10 point scale. This represents a 30% reduction in exacerbation score post study. When asked, “I understand and I am able to identify CF pulmonary exacerbation better since I participated in the SUBB study” 19 of the 38 respondents “agreed” and 14 “strongly agreed”. Conclusion: Using home spirometry may help to identify early exacerbation in CF. While the results were positive overall, further studies such as a blinded, multi-center study could be accomplished to further investigate results. Sponsored Research - None