Quality statement 3: Treating chronic lung infection

Quality statement

People with cystic fibrosis who have chronic Pseudomonas aeruginosa infection have sustained treatment with an inhaled antibiotic.

Rationale

Lung infection is the cause of much of the morbidity and mortality associated with cystic fibrosis. Pseudomonas aeruginosa is the most frequent cause of lung infection in people with cystic fibrosis. Chronic infection with Pseudomonas aeruginosa leads to worsening signs and symptoms and reduced lung function. Long-term treatment with an inhaled antibiotic suppresses Pseudomonas aeruginosa infection and helps to maintain lung function and quality of life.

Quality measures

Structure

a) Evidence of local arrangements to identify people with cystic fibrosis who have Pseudomonas aeruginosa infection.

Data source: Local data collection, for example protocols for microbiological surveillance of respiratory secretions.

b) Evidence of the availability of devices for people with cystic fibrosis to take inhaled antibiotics.

Data source: Local data collection, for example from service protocols. NHS England service specifications for cystic fibrosis require a comprehensive nebuliser service to provide devices that deliver drugs in a fast and efficient manner.

Process

Proportion of people with cystic fibrosis who have chronic Pseudomonas aeruginosa infection prescribed an inhaled antibiotic.

Numerator – the number in the denominator who are prescribed an inhaled antibiotic.

Denominator – the number of people with cystic fibrosis who have chronic Pseudomonas aeruginosa infection.

Data source: Local data collection, for example local audit of patient records.

Outcome

Lung function (forced expiratory volume in 1 second [FEV1]) of people with cystic fibrosis.

Data source: Local data collection, for example local audit of patient records. Appendix 2 of the UK Cystic Fibrosis Registry annual data report includes FEV1 converted from absolute litres of air blown out into a predicted percentage. The predicted percentage is based on the FEV1 expected for a person without cystic fibrosis of the same age, gender, height and ethnicity.

What the quality statement means for different audiences

Service providers (such as cystic fibrosis centres and hospitals) have access to microbiology services and systems to identify people with cystic fibrosis who have chronic Pseudomonas aeruginosa infection. They have protocols to prescribe inhaled antibiotics for sustained use to people with cystic fibrosis when eradication treatment has not worked; and to monitor the effects of the treatment.

Healthcare professionals (such as cystic fibrosis specialist paediatricians and adult physicians) make sure that people with cystic fibrosis have frequent microbiological surveillance of respiratory secretions and that eradication is attempted for first and subsequent new Pseudomonas aeruginosa infections. They prescribe inhaled antibiotics for sustained use if eradication treatment has not worked, and discuss adherence and the benefits and harms of the treatment with the child, young person or adult with cystic fibrosis and their family or carer.

Commissioners (NHS England and clinical commissioning groups) ensure that service specifications require sustained treatment with an inhaled antibiotic for people with cystic fibrosis who have chronic Pseudomonas aeruginosa infection when eradication treatment has not worked.

People with cystic fibrosis who have a long-term lung infection called Pseudomonas aeruginosa take an antibiotic medicine that they inhale (breathe in) to benefit their lungs. The medicine will not get rid of the infection, but it will help to keep it under control.

Source guidance

Cystic fibrosis: diagnosis and management (2017) NICE guideline NG78, recommendation 1.6.34

Definitions of terms used in this quality statement

Chronic Pseudomonas aeruginosa

Pseudomonas aeruginosa is a bacterial infection that affects the lungs. It is chronic if there have been 3 or more isolates in the preceding 12 months.

[NICE's guideline on cystic fibrosis: diagnosis and management, glossary in full guideline and expert opinion]

Sustained treatment

Long-term treatment intended to supress and control an infection after attempts to eradicate it have not worked.

[Expert opinion]