Challenges in Implementing Routine Cardiopulmonary Exercise Testing in Cystic Fibrosis Clinical Practice: a Single-Centre Review

Cardiopulmonary exercise testing (CPET) is viewed by many as the gold standard for assessing exercise capacity in CF, being recommended on an annual basis. However, not all patients undergo CPET for varying reasons. This service evaluation retrospectively reviewed data from 179 (92 male) patients in a single CF centre in the UK to identify such reasons. A total of 75/179 patients underwent CPET, whilst 104/179 did not. Of these 104, 41 patients were ≤ 11 years of age. Of the remaining 63 patients, 26 did not undergo CPET for clinical reasons including needing IV antibiotics, musculoskeletal issues and obesity. Seventeen refused to undergo CPET because of reasons such as an unwillingness to travel and dislike of CPET. Twenty did not undergo CPET for miscellaneous reasons including difficulty contacting patients. Individuals with FEV1 < 40%predicted were 85.7% less likely to undertake a CPET than individuals with FEV1 ≥ 70%predicted. Understanding these challenges will assist clinical teams with future implementation of CPET into routine care, by identifying areas for improvement and establishing strategies for enhancing future provision of the test.