Serum 25(OH)D levels are significantly associated with pulmonary function in CF. Further study is required to determine whether this association is causal.

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The present survey provides current data describing the use of CAM in patients with CF and adds to the increasing body of evidence about CAM use in the United States. Further research is needed to explore the relationship and effectiveness of specific types of CAM practices and their benefits on symptom relief and overall quality of life of CF patients.

Background Our centre's median forced expiratory volume in one second (FEV 1 ) reported in the 2005 Cystic Fibrosis (CF) Foundation Patient Registry was below the national median. The focus of our quality improvement initiative was to improve lung function through re-education of airway clearance techniques (REACT). Aim The global aim was to improve the median FEV 1 in our patients. The specific aim was to encourage adherence to airway clearance techniques (ACT). To achieve these goals we implemented the REACT programme for patients. Methods Educational sessions introduced the concept of improving clinical outcomes and the importance of airway clearance in achieving optimal lung function. The REACT programme utilised an anonymous survey, in-clinic questionnaire and ACT demonstration to assess knowledge, practices and barriers to ACT. Patients were then categorised as non-adherent or adherent with correct or incorrect technique. Improper techniques were corrected. All patients were re-educated on the rationale for ACT. Results Our surveys revealed that 43% of patients had barriers to ACT and 53% were non-adherent. Following implementation of REACT, median FEV 1 increased from 84% to 92% (national median 91-94%) from 2005 to 2010 for patients aged 6-17. For patients 18 and older, median FEV 1 increased from 56% to 64% (national median 62-65%) from 2005 to 2010. Conclusions By introducing a programme focused on technique and adherence, we were able to improve median FEV 1 in patients with CF. Sustained improvement of FEV 1 was accomplished by continued use of the REACT programme.