title: The impact of re-education of airway clearance techniques (REACT) on adherence and pulmonary function in patients with cystic fibrosis.
abstract: BACKGROUND
  Our centre's median forced expiratory volume in one second (FEV1) 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).
  
  
  OBJECTIVE
  The global aim was to improve the median FEV1 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 FEV1 increased from 84% to 92% (national median 91-94%) from 2005 to 2010 for patients aged 6-17. For patients 18 and older, median FEV1 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 FEV1 in patients with CF. Sustained improvement of FEV1 was accomplished by continued use of the REACT programme.
authors.affiliation: Pediatric Pulmonary and Cystic Fibrosis, Barnabas Health, Monmouth Medical Center, , Long Branch, New Jersey, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Zanni
authors.forename: Eduardo U
authors.initials: EU
authors.lastname: Sembrano
authors.forename: Doantrang T
authors.initials: DT
authors.lastname: Du
authors.forename: Bridget
authors.initials: B
authors.lastname: Marra
authors.forename: Ronald
authors.initials: R
authors.lastname: Bantang
mesh_terms: D000293:Adolescent; D000328:Adult; D058109:Airway Management / Q000379:methods; D002648:Child; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000503:physiopathology / Q000628:therapy*; D015916:Drainage, Postural / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D009079:Mucociliary Clearance; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods*; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: Clinical Microsystem; Compliance; Quality Improvement