Objective: This investigation sought to evaluate the prevalence and imaging characteristics of tracheal diverticula (TD) among patients with cystic fibrosis (CF). Methods: A total of 113 patients with CF at our institution, with a median age of 29 years, had chest CT examinations between 2002 and 2014. These imaging studies were retrospectively reviewed to assess for the presence and characteristics of TD, including quantity, size and location. The severity of the CF disease was assessed using the Bhalla CT scoring system and pulmonary function tests. Results: Of the 113 cases reviewed, 20 (17.7%) patients were found to have 1 or more TD. The presence of TD was associated with more severe disease by imaging criteria, with a Bhalla CT score of 13.9 6 4.3 in patients with TD and 11.5 6 4.3 in patients without TD. For the pulmonary function tests, forced expiratory volume in 1 s (FEV1) and FEV1 percent predicted demonstrated a trend towards worsening function in patients with TD, although the difference was not statistically significant. Conclusion: The prevalence of TD in our patient population with CF based on chest CT exams was 17.7%. In addition, the presence of TD was associated with more severe CF disease by imaging criteria. Advances in knowledge: TD appear to have a higher prevalence in patients with CF than in the general population, are associated with more severe CF pulmonary disease by CT criteria and are frequently underreported by radiologists.

The coronavirus disease 2019 (COVID-19) pandemic has demanded large scale changes in patient care. People with cystic fibrosis have unique considerations, including underlying lung disease and routine aerosolizing therapies, but there is insufficient evidence to create comprehensive practice guidelines. We share a case of a patient with CF and COVID-19 as well as alterations to routine CF care at a large academic center. Key considerations include accessible COVID-19 screening, augmented infection control practices, and rapid integration of telemedicine.

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Lay Summary The coronavirus disease 2019 (COVID-19) pandemic has resulted in the need to incorporate telemedicine as a form of patient care. Cystic fibrosis (CF) is a genetic disease affecting the lungs and multiple other organs. CF patients require frequent clinic visits for disease monitoring and medication management provided by a team of physicians, respiratory therapists, nurses, dietitian, and social workers. We share our CF center’s experience with video visits replacing in-person clinic evaluation during the pandemic using a patient and staff survey. Our results showed the telemedicine care model was convenient, efficacious, and similar to in-person visits, with interest for its continued beyond the pandemic. ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic has resulted in large scale changes to incorporate telemedicine for delivery of care. People with cystic fibrosis (CF) have care considerations that pose challenges to telemedicine; they include frequent visits for pulmonary disease progression, medication management and evaluation by a multidisciplinary team of providers. We share our center’s experience with video visits replacing in-person clinic evaluation, using quality improvement strategies to create a replicable workflow. Key considerations include incorporation of the multidisciplinary team into the visit, limitations of remote delivery of care, as well as patient and staff perceptions of this care model. Results revealed that video visits were convenient, efficacious, and comparable to in-person visits with interest for its continued incorporation into the traditional CF care model.

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