P410 The impact of the COVID 19 pandemic and modulator therapy on routine respiratory sampling in paediatric cystic fibrosis (CF)

Respiratory sampling is a crucial part of monitoring children with CF. We reviewed sampling practice between January 2020-December 2022 to ensure compliance with UK and local guidance. This period included the COVID 19 pandemic and introduction of modulator therapy. Retrospective review of hospital system data was performed over 3 years. Patients were aged between 0–17 years and were managed at a tertiary centre. Patients under shared care or had CF SPID were excluded. Those not under care for a full 12-month period were not included in the analysis for that year. The frequency and type of sampling was compared against National Institute for Health and Care Excellence (NICE) (4 samples a year) and local guidance (6 samples a year). Data from 125,101 and 97 patients were reviewed in 2020, 2021 and 2022. In 2020, 48.8% (61) of patients met either NICE or local guidelines, 87% (88) in 2021 and 82% (80) in 2022. Following the initial yearof data collection, leaflets, remote sampling and an increase in face-to-face encounters were introduced. Despite these, in 2022 17.5% (17) continued to not meet either guideline. Of the remainder, 47% (46) had 4+ samples per year while 35% (34) had 6+ samples per year. There was a reduction in sputum samples compared to cough swabs: of the 642 samples taken in 2021, 34% (216) were sputum samples compared to 25% (132 out of 544) in 2022. A number of factors contributed to changes in paediatric CF respiratory sampling. Decreased sampling in 2020 was due to the COVID-19 pandemic and a shift to virtual health care. The subsequent improvement in 2021 likely reflects the introduction of remote sampling and increased face-to-face reviews. However adequate sampling is still not achieved in 17.5% of patients. The falling proportion of sputum samples most likely reflects decreased sputum production in patients established on modulator therapy highlighting the need for induced sputum sampling.