key: cord-0721340-3vfnj0uu authors: Hatziagorou, Elpis; Toulia, Ilektra; Avramidou, Vasiliki; Kampouras, Asterios; Tsara, Venetia; Tsanakas, John title: Change in CF care during COVID‐19 pandemic: Single‐center experience in a middle‐income setting date: 2021-07-15 journal: Pediatr Pulmonol DOI: 10.1002/ppul.25560 sha: 43f616737e819d644de38f4be288c61d6abae894 doc_id: 721340 cord_uid: 3vfnj0uu INTRODUCTION: The coronavirus 2019 (COVID‐19) pandemic has demanded care changes for patients with chronic disease. Patients with cystic fibrosis (CF) are considered at higher risk of developing severe manifestations in the case of SARS‐CoV‐2 infection, and a need for new ways of safer care delivery has been required to avoid transmission. OBJECTIVES: To assess the impact of the lockdown during the first wave of the COVID‐19 pandemic and remote monitoring on patient's health status and daily maintenance therapy in a middle‐income resource setting. METHODS: During the first wave of the pandemic period, we changed from regular clinic visits to telephone visit calls to monitor our patients' health condition and adherence to physiotherapy and physical exercise. RESULTS: A total of 120 patients or their caregivers have been contacted by telephone call visits over 10 weeks. During this period, 38 patients (28.33%) were identified to have pulmonary exacerbation; 89.5% were prescribed oral antibiotics, 3% were hospitalized to get iv antibiotics, and 8% of the patients presented other CF complications. Most of the patients did not change the frequency of the daily physiotherapy. Moreover, 71% of the patients who performed regular physical exercise changed the frequency and the type of exercise during the quarantine period. Interestingly, mean forced expiratory volume in 1 s and body weight increased significantly and after the lockdown period. CONCLUSIONS: During the COVID‐19 pandemic, the implementation of telephone contact processes aiming for CF patients' appropriate care is of great importance. Further studies are needed to evaluate patient outcomes when transitioning from face‐to‐face clinics to telemedicine clinics. Methods: During the first wave of the pandemic period, we changed from regular clinic visits to telephone visit calls to monitor our patients' health condition and adherence to physiotherapy and physical exercise. Results: A total of 120 patients or their caregivers have been contacted by telephone call visits over 10 weeks. During this period, 38 patients (28.33%) were identified to have pulmonary exacerbation; 89.5% were prescribed oral antibiotics, 3% were hospitalized to get iv antibiotics, and 8% of the patients presented other CF complications. Most of the patients did not change the frequency of the daily physiotherapy. Moreover, 71% of the patients who performed regular physical exercise changed the frequency and the type of exercise during the quarantine period. Interestingly, mean forced expiratory volume in 1 s and body weight increased significantly and after the lockdown period. Conclusions: During the COVID-19 pandemic, the implementation of telephone contact processes aiming for CF patients' appropriate care is of great importance. Further studies are needed to evaluate patient outcomes when transitioning from face-to-face clinics to telemedicine clinics. COVID-19, cystic fibrosis, monitoring, telemedicine, telephone visits The coronavirus 2019 (COVID-19) pandemic has become a significant world health problem. 1 Many countries have recommended quarantine to decrease person-to-person transmission of COVID-19, 2 while most cystic fibrosis (CF) centers have advised their CF populations to isolate socially. 3 Traditionally, consistent follow-up care with frequent hospital visits is required to avoid a decline in pulmonary and nutritional health among CF patients. During the COVID-19 pandemic, many hospitals shifted their workforces to the rapidly escalating numbers of COVID-19 admissions and halted routine clinical work, including outpatient services, to limit contamination and infection risks. 2 Thus emerged the paramount need to monitor chronic patients at home through virtual visits using telemedicine. 3 To comply with the social distancing policy and follow up with our patients regularly, having at the same time a financial resources limitation, our CF center contacted all its patients via phone to monitor their clinical condition and health care needs during the first quarantine period. The aim of this study was to assess the impact of remote monitoring on patient's health status and daily maintenance therapy in a middle-income resource setting. A prospective study was conducted among children and adults with CF from March 2020 until May 2020, now recognized as the pandemic's first wave. A CF nurse performed monthly telephone visit calls with our CF patients during the quarantine period. A questionnaire was used to collect information directly from the patients or their caregivers on their medical condition, change in respiratory and gastroenteric symptoms, current weight, fever, or any other complications/complaints; moreover, medication adherence, physiotherapy, and physical exercise were recorded. The multidisciplinary CF team (MDT) performed regular meetings to discuss the issues that were pointed out in the telephone calls. If required, antibiotics or bronchodilators were prescribed for a possible pulmonary exacerbation or a hospital visit, and possible admission was arranged. The study was approved by the "Hippokration Hospital of Thessaloniki" Ethics Committee. Informed consent was obtained from all the patients or guardians if the patients were under 18 years. Descriptive statistics were used to analyze the study population. The decline in FEV1 is typical of almost all patients with CF. 2 Interestingly there was an increase in FEV1 after the lockdown period, compared to the period before the COVID-19 pandemic, which might be explained by the fact that our patients had fewer chest infections, probably because of the low spread of viral infections due to the lockdown measures. 1 Home isolation with a low incidence of viral infections, less physical activity, and more ultraprocessed food eating may also explain the weight gain over the quarantine period. Physiotherapy is an essential component of CF care, including airway clearance and exercise; our patients were encouraged to follow self-physiotherapy programs and physical exercise to maintain their physical fitness. Due to social distancing measures, most families with CF patients have stopped the assisted physiotherapy home care program. Physical exercise forms an essential part of T A B L E 1 Impact of the COVID-19 pandemic on patients' daily airways clearance and physical activity We would like to acknowledge all the patients and their families for agreeing to participate anonymously in this study; we would also like to acknowledge our CF nurse, Efrosyni Kalaitzidou, for contacting all the families and supporting them, especially during this period of social distancing. Impact of COVID-19 on people with cystic fibrosis The coronavirus pandemic has forced rapid changes in care protocols for cystic fibrosis A feasibility study of urgent implementation of cystic fibrosis multidisciplinary telemedicine clinic in the face of COVID-19 pandemic: single-center experience Recommended shielding against COVID-19 impacts physical activity levels in adults with cystic fibrosis The authors declare that there are no conflict of interests.