Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Cystic Fibrosis Foundation, Bethesda, Maryland; and.
Ann Am Thorac Soc. 2022 Oct;19(10):1697-1703. doi: 10.1513/AnnalsATS.202105-532OC.
Cystic fibrosis (CF) centers transitioned to telemedicine during the spring 2020 peak of the coronavirus disease (COVID-19) pandemic. We hypothesized that people with CF (pwCF) with more severe disease would be more likely to be seen in-person. We used paired tests to compare within-subject changes in body mass index (BMI) and percentage predicted forced expiratory volume in one second (FEV) and calculated relative risk (RR) to compare pulmonary exacerbations (PEx) between pwCF enrolled in the CF Foundation Patient Registry with at least one in-person clinic visit after March 15 in both 2019 and 2020. Overall, the proportion of clinical encounters that were in-person clinic visits decreased from 91% in 2019 to a low of 9% in April 2020. Among pwCF seen after March 15 in both 2019 and 2020, the mean (95% confidence interval [CI]) FEV percentage predicted was 1.3% (0.1-2.4) predicted higher in 2020 for children 6 to <12 years of age, and 7.5% (7.1-7.9) predicted higher in 2020 among pwCF ⩾12 years of age eligible for the highly effective CF transmembrane conductance regulator modulator, elexacaftor-tezacaftor-ivacaftor (ETI). There was no difference in FEV percentage predicted for pwCF ⩾12 years of age who were not eligible for ETI. Similarly, the mean (95% CI) BMI was 2.4 (2.0-2.8) percentile higher in 2020 for children 6 to <12 years of age and 5.2 (4.8-5.7) percentile higher in 2020 among children 12 to <18 years of age eligible for ETI. Mean (95% CI) BMI was 1.2 (1.2-1.3) (kg/m) higher for pwCF ⩾18 years of age eligible for ETI, and 0.2 (0.1-0.3) (kg/m) higher for pwCF ⩾18 years of age not eligible for ETI. The proportion of in-person clinic visits where any PEx was present was lower in 2020 compared with 2019, 25% compared with 38%, RR 0.82 (0.79-0.86). The care of pwCF was substantially changed during the spring 2020 peak of the COVID-19 pandemic. Among pwCF seen in-person in both 2019 and 2020 after the spring peak of the COVID-19 pandemic, lung function and BMI were higher in 2020 for children 6 to <12 years of age and pwCF eligible for ETI.
囊性纤维化 (CF) 中心在 2020 年春季冠状病毒病 (COVID-19) 大流行高峰期转向远程医疗。我们假设疾病更严重的 CF 患者 (pwCF) 更有可能接受面对面治疗。我们使用配对检验比较了 2019 年和 2020 年 3 月 15 日后至少有一次面对面诊所就诊的 CF 基金会患者登记处中 pwCF 的体重指数 (BMI) 和预计用力呼气量的百分比 (FEV) 的个体内变化，并计算了相对风险 (RR) 以比较 pwCF 的肺部恶化 (PEx)。总体而言，面对面诊所就诊的临床就诊比例从 2019 年的 91%下降到 2020 年 4 月的 9%。在 2019 年和 2020 年 3 月 15 日后接受治疗的 pwCF 中，6 至 <12 岁儿童 2020 年的 FEV 预计百分比预测值高出 1.3% (0.1-2.4)，12 岁及以上有资格接受高效 CF 跨膜电导调节剂调节剂，埃利卡法特-泰卡法特-依伐卡法特 (ETI) 的 pwCF 高出 7.5% (7.1-7.9)。不符合 ETI 条件的 12 岁及以上 pwCF 的 FEV 预计百分比预测值没有差异。同样，6 至 <12 岁有资格接受 ETI 的儿童 2020 年的平均 (95%CI) BMI 高出 2.4 (2.0-2.8) 个百分点，12 至 <18 岁有资格接受 ETI 的儿童 2020 年的平均 (95%CI) BMI 高出 5.2 (4.8-5.7) 个百分点。符合 ETI 条件的 18 岁及以上 pwCF 的平均 (95%CI) BMI 高出 1.2 (1.2-1.3) (kg/m)，不符合 ETI 条件的 18 岁及以上 pwCF 的平均 (95%CI) BMI 高出 0.2 (0.1-0.3) (kg/m)。2020 年面对面诊所就诊中任何 PEx 存在的比例低于 2019 年，分别为 25%和 38%，RR 0.82 (0.79-0.86)。在 2020 年春季 COVID-19 大流行高峰期，pwCF 的护理发生了重大变化。在 2019 年和 2020 年春季 COVID-19 大流行高峰期后接受面对面治疗的 pwCF 中，6 至 <12 岁儿童和有资格接受 ETI 的 pwCF 的肺功能和 BMI 在 2020 年更高。
