The virtual CF clinic: Implications for sputum microbiology

Abstract

The COVID19 pandemic has shifted the paradigm of how outpatient clinics are delivered within CF care, resulting in a significant reduction of patient visits to CF centres. One consequence of this has been a reduction in the number of sputa/cough swabs that patients submit for routine analysis. This report examines why it is important to maintain optimal sputum microbiology and explores (i). the microbiological efficiency of postal submission of sputum specimens from the community and (ii) the regulatory conditions that must be met through postal submission of respiratory specimens. Virtual clinics have now been established within CF care and it is incumbent on each speciality within the CF MDT to explore ways to nurture and support their individual contribution to the success of the virtual clinic. Within microbiology, adopting innovative approaches to sputum collection in the community and transportation via postal services will allow for continued microbiological vigilance thereby supporting patient safety.

Cystic Fibrosis Respiratory Microbiology Monitoring during a Global Pandemic: Lessons Learned from a Shift to Telehealth

“…Specialist centers should be aware of the transport requirements for each sample type and plan service modifications accordingly to ensure adequate microbiology monitoring is maintained during the shift to telehealth care. (7) The limitations of our study include the single-center nature of this analysis, as well as the exclusion of CFTR modulatortreated patients, both of which might limit the generalizability of our findings. CFTR modulator therapies are rapidly becoming standard of care in CF but we felt they would represent a significant confounder in our analysis (especially if started just before or early during the pandemic) since they can reduce spontaneous sputum production and the primary focus of our audit was to assess the impact of the pandemic on microbiological acquisition due to a change in the care delivery model from in-person care to telehealth.…”

“…Home-performed cough swabs may be an option for monitoring younger patients and those not producing sputum regularly ( 6 ), whereas induced sputum production should be encouraged for those patients already established on nebulized saline. Specialist centers should be aware of the transport requirements for each sample type and plan service modifications to ensure adequate microbiology monitoring is maintained during the shift to telehealth care ( 7 ). The limitations of our study include the single-center nature of this analysis as well as the exclusion of CFTR modulator–treated patients, both of which might limit the generalizability of our findings.…”

Telehealth and virtual health monitoring in cystic fibrosis

“…These include physical examination, lung function assessment and collection of biospecimens such as sputum, cough swabs and blood samples. There are some data to support the feasibility of home spirometry in people with CF [33 ▪ ], and the use of postal/shipping services for the collection of biospecimens [37], however replicating a physical examination is more difficult and needs development.…”

Detection of bacterial pathogens using home oropharyngeal swab collection in children with cystic fibrosis

“…Drawbacks to the use of telemedicine in CF care include practical considerations such as implementation costs and patient access to appropriate technology, as well as clinical concerns including lack of a complete physical exam, lack of spirometry data, and lack of ability to collect airway cultures 4 . Home‐based spirometry has demonstrated feasibility in children with CF, 5,6 and home collection of sputum specimens has been used in CF clinical care 7,8 . OP cultures are the mainstay of airway surveillance for children with CF who do not spontaneously expectorate sputum 9 .…”