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COVID-19 Lockdown Impacts Among Patients with Cystic Fibrosis: An Italian Regional Reference Centre Experience
Alessandra Boni1, Manuel Murciano1,2, Francesca De Luca1
1Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 155, 00161 Rome, Italy.
Insights
The COVID-19 lockdown positively impacted cystic fibrosis (CF) patients, particularly males, improving weight and body mass index (BMI). Moderate respiratory function patients saw the greatest nutritional benefits, with some lung function stabilization observed.
Area of Science:
- Medical Science
- Pulmonology
- Chronic Disease Management
Background:
- The COVID-19 pandemic necessitated social distancing measures, impacting chronic disease management.
- Cystic Fibrosis (CF) patients experienced reduced outpatient visits and social interactions during the Italian lockdown (March-May 2020).
Purpose of the Study:
- To evaluate the impact of the COVID-19 lockdown on body mass index (BMI) and lung function in cystic fibrosis (CF) patients.
- To assess changes in nutritional status and respiratory parameters during the lockdown period.
Main Methods:
- Retrospective review of clinical data from 111 CF patients (pre-lockdown Oct 2019-Mar 2020, post-lockdown May-Oct 2020).
- Collected data on weight, BMI, and lung function (FEV1, FEF 25-75%, Tiffenau index, CVF).
- Telephone interviews assessed physical activity, exacerbations, and adherence to therapy, physiotherapy, and diet.
Main Results:
- Overall increase in weight observed; male patients showed greater improvements in weight, BMI, FEF 25-75%, and Tiffenau index.
- Severely compromised patients (FEV1 <40%) experienced significant weight and BMI loss.
- Moderately compromised patients (FEV1 40-70%) showed significant weight and BMI increase, with a slight CVF reduction.
- Patients reported reduced physical activity but increased adherence to therapy (43%) and physiotherapy (47.6%).
Conclusions:
- The lockdown period offered benefits for CF patients, particularly in weight management, especially for males.
- Nutritional status improved most in patients with moderate respiratory function impairment.
- Lung function showed stabilization or slight improvement, contrasting with the typical annual decline in CF patients.
Background:
Coronavirus pandemic has influenced our society with social distancing and management of chronic disease such as cystic fibrosis (CF). During the Italian lockdown from March to May 2020, CF patients reduced the number of outpatient visits, limited social interactions and spent more time at home. The aim of this study is to evaluate the impact of the lockdown on body mass index (BMI) and lung function tests on CF patients.
Methods:
We retrospectively reviewed clinical data about 111 CF patients followed in our Regional Cystic Fibrosis Reference Centre (Policlinico Umberto I, Rome) according to two periods: pre-lockdown (from October 2019-March 2020) and post-lockdown (from May 2020-October 2020). We collected data on nutritional (BMI and body weight) and lung function status; we chose the best values of the 'pre-lockdown' and 'post-lockdown' period for each patient. Patients were divided into 3 groups according to FEV1 value (Forced Expiratory Volume in the 1st second): group 1 (FEV1 <40%), group 2 (FEV1 40-70%), group 3 (FEV1 >70%). All patients received a telephone interview asking for the number of hours per week devoted to physical activity, number of pulmonary acute exacerbations and subjective evaluation of adherence to medical therapy, respiratory physiotherapy and diet, during the two periods.
Results:
Comparing weight, BMI and respiratory function between pre and post lockdown periods, we noticed an increase in weight during among overall patients. Male patients improved weight, BMI, FEF 25-75% (Forced Expiratory flow between 25% and 75% of vital capacity) and Tiffenau index more than female patients. The most severely compromised patients (group 1), showed a significant loss of both weight and BMI. Instead, patients with moderate respiratory function (group 2) showed a significant increase of both weight and BMI and a slightly reduced CVF (Forced Vital capacity). We found no differences among patients with good respiratory function (group 3). Comparing each clinical sub-groups, we noticed a significative improvement of weight (p = 0.018) and BMI (p = 0.030) among patients with moderate respiratory function compared to patients with compromised respiratory function. During lockdown, patients reported less physical activity, no variation in food amount and composition, more adherence to therapy (43%) and more consistent daily respiratory physiotherapy (47.6%).
Conclusions:
Lockdown period had benefit among CF patients in terms of weight in particular in male patient. The greatest benefit on nutritional state was observed in patients with moderate reduction of respiratory function. In addition, we noted a stabilization and sometimes a slight improvement of lung function, instead of a continuous and steady decline that is normally observed in CF patients. These beneficial effects are slight but significative, bearing in mind the general worsening that CF patients experience annually.
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