(87) Increasing inhaled hypertonic saline therapy in pediatric patients with cystic fibrosis.

Background: Cystic Fibrosis (CF) is a genetic disorder characterized by progressive lung function decline contributing to increased morbidity and mortality. Airway clearance and aerosol medications help slow this decline. Inhaled hypertonic saline (HTS) increases airway surface liquid in the lungs of individuals with CF aiding in mucociliary clearance. In 2007, the CF Foundation published guidelines on the recommended chronic medications for the maintenance of lung health, which included inhaled HTS for children 6 years and older. Newer evidence suggest HTS can benefit children younger than 6 years. In 2018 the CF Foundation Patient Registry (CFFPR) report began including data on HTS use in patients 2-5 years. According to the 2019 CFFPR report, HTS use in patients 2-5 years at our CF Center was below the national average; 23% vs 45%, respectively. As a result, we initiated a quality improvement (QI) project aimed at increasing HTS use, particularly in patients 2-5 years.

Methods: Our primary aim is to increase the use of HTS in patients 2-5 years from 23% to above the national average of 45% by December 2021. We created a key driver diagram to help organize ideas and identify potential barriers to achieving our aim. We shared the aim of our initiative with the CF team and provided education about benefits of HTS in children with CF. We distributed an educational handout to the families in our CF center. A process map was developed to create a workflow to better achieve our aim. A list was generated from our CFFPR to identify those eligible for HTS. At weekly pre-visit planning meetings, children eligible for HTS were identified by respiratory therapist (RT) and approached during the routine clinic visit about initiating HTS therapy. If agreeable, the RT administered the first dose of 7% HTS and assessed tolerance. Tolerance was defined as the absence of any clinical signs of distress or wheezing. Children old enough to perform pulmonary function testing (PFT), baseline or better pre-HTS PFT was required prior to administering HTS. A post-HTS PFT was performed. A decline in FEV1% predicted of 10 % or more was regarded as intolerance. If patients did not wheeze or experience a decline in their post-HTS PFT, then HTS was prescribed.

Results: In 2020, the CFFPR reported a slight increase in HTS use in the 2–5-year group at Lurie Children’s; 23% to 27.6%. At the time of this abstract submission, our 2021 CFFPR report was pending; however, our own calculations at the launch of this HTS QI project in April of 2021 revealed HTS use in the 2–5-year group to have risen to 41%. This increase from 27.6% to 41% happened while we were in the planning stages of the HTS project, suggesting that simply being aware of HTS use among our patients contributed to the increase. From April 2021 to March 2022 HTS use increased in patients 2-5 years from 41% to 57% [Figure 1].










Conclusions: The HTS QI initiative at Lurie Children’s CF Center was successful at achieving an increase in HTS use in patients 2-5 years. We plan to maintain our current process for implementing HTS therapy with the goal of improving HTS use at our pediatric CF Center. It is worth noting that continuing to focus on adding HTS to daily therapies will likely need to be re-examined in the era of highly effective modulator therapies.

Acknowledgements:

References: