BMJ Qual Saf 23:i50-i55 doi:10.1136/bmjqs-2013-002352
  • Ten years of improvement innovation in cystic fibrosis care

The impact of re-education of airway clearance techniques (REACT) on adherence and pulmonary function in patients with cystic fibrosis

  1. Ronald Bantang
  1. Pediatric Pulmonary and Cystic Fibrosis, Barnabas Health, Monmouth Medical Center, Long Branch, New Jersey, USA
  1. Correspondence to Robert L Zanni, Monmouth Medical Center, Pediatric Pulmonary and Cystic Fibrosis, Barnabas Health, 279 3rd Ave., Suite 604, Long Branch, NJ 07740, USA; rzanni{at}
  • Received 24 July 2013
  • Revised 10 December 2013
  • Accepted 13 December 2013


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).

Aim 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.

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