The COVID-19 pandemic disrupted many aspects of people’s lives. Coping with restrictive measures adopted in several countries for disease containment had a profound impact on individuals’ mental health, including those with chronic disorders.

“The worse survival rates in those with chronic conditions have been cause for concern in the cystic fibrosis (CF) community, [which] perceived the chronic lung infection peculiar to CF as a significant risk factor for poor COVID-19 outcomes,” explained Ciprandi et al in an article published in the Journal of Cystic Fibrosis.

However, several studies have highlighted the resilience of patients with CF in coping with the pandemic and even found the lockdown led to positive changes to some patients.

Therapeutic Adherence

“The suspension of most of the work activities and the empowering of work from home resulted in the availability of more time for a greater therapeutic adherence,” concluded Boni et al who conducted a retrospective study that enrolled 111 patients with CF followed at the Regional Cystic Fibrosis Reference Centre, Italy.

Nearly half (43%) of participants mentioned having a greater adherence to both pharmacological treatment and physiotherapy during the lockdown. Moreover, 47.6% confirmed they were more consistent and effective in performing respiratory physiotherapy on a daily basis.

Lung Function

“At the end of the lockdown, we reviewed our patients for routine visits and, among those who had adhered to the restrictive measures, we noticed a marked improvement in clinical conditions and functional lung parameters,” Servidio et al wrote in an article published in the Italian Journal of Pediatrics.

That research group found a significant increase in forced expiratory volume in the first second (FEV1) when analyzing data collected before and after the lockdown from 34 patients (median age, 22.5 years, age range, 8 to 42 years) followed at the Regional Centre for the Diagnosis and Treatment of Cystic Fibrosis of the Institute for Maternal and Child Health, Trieste, Italy.

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Similarly, Boni et al also verified improvements in forced expiratory flow between 25% and 75% of vital capacity and FEV1/forced vital capacity (FVC) ratio in males patients after the lockdown. Female participants presented with decreased FVC post-lockdown. Moreover, participants with severe disease showed less capacity for improvement than participants with moderate disease.

Psychological Effects

Ciprandi et al found similar levels of psychological distress between adults with CF and the general population. They also reported a 55% higher level of mild-moderate anxiety-associated symptoms in the control group, compared to the CF group. “This might be sustained by lifelong experiences in coping with the demands of their chronic disease,” Ciprandi et al said.

Gender analysis of the CF patients enrolled in Ciprandi et al’s study showed a higher frequency of psychological distress, as well as anxiety, depression, and physical symptoms in females than in males. No correlation was found between psychological distress and the degree of pulmonary function impairment.

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Children with CF also revealed less symptoms of anxiety than healthy controls. “Feeling upset for school closure, worries about a family member having the risk of COVID-19 infection, feeling sad, lonely or reluctant to have playful time, overthinking about pandemic are all more common psychological reactions regarding pandemic in the control group than in the CF patients,” concluded Yanaz et al in a study recently published in Pediatrics International. The controlled cross-sectional study enrolled 132 CF patients aged 7 to 18 years old.

Physical Activity

The study conducted by Boni et al found that most (70.7%) patients reduced the time dedicated to sports and physical activity during the lockdown, whereas diet remain similar to prepandemic times for 52.4% of participants. Male participants showed improved weight and body mass index (BMI) after the lockdown period.

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Radtke et al also found a negative impact of COVID-19-related restrictions on physical activity. “Our survey revealed long-term consequences of COVID-19 shielding on individuals’ physical activity behavior with 46% of [people with CF] reporting to undertake less physical activity during the pandemic.”

Eventual consequences of the lower practice of physical activity by CF patients during the pandemic period remain to be determined.

References

Boni A, Murciano M, De Luca F, et al. COVID-19 lockdown impacts among patients with cystic fibrosis: an Italian regional reference centre experience. Front Biosci. 2022;27(6):178. doi:10.31083/j.fbl2706178

Servidio AG, Capata G, Levantino L, et al. COVID-19 lockdown beneficial effects on lung function in a cohort of cystic fibrosis patients. Ital J Pediatr. 2021;47(1):12. doi:10.1186/s13052-021-00970-4

Ciprandi R, Bonati M, Campi R, Pescini R, Castellani C. Psychological distress in adults with and without cystic fibrosis during the COVID-19 lockdown. J Cyst Fibros. 2021;20(2):198-204. doi:10.1016/j.jcf.2020.12.016

Yanaz M, Yilmaz Yegit C, Ergenekon AP, et al. The effect of coronavirus disease 2019 on anxiety levels of children with cystic fibrosis and healthy peers. Pediatr Int. 2022;64(1):e15009. doi:10.1111/ped.15009

Radtke T, Haile SR, Dressel H, Benden C. COVID-19 pandemic restrictions continuously impact on physical activity in adults with cystic fibrosis. PLoS One. 2021;16(9):e0257852. doi:10.1371/journal.pone.0257852