TY - JOUR T1 - Variation in treatment preferences of pulmonary exacerbations among Australian and New Zealand cystic fibrosis physicians JF - BMJ Open Respiratory Research JO - BMJ Open Resp Res DO - 10.1136/bmjresp-2021-000956 VL - 8 IS - 1 SP - e000956 AU - Grace Currie AU - Anna Tai AU - Tom Snelling AU - André Schultz Y1 - 2021/07/01 UR - http://bmjopenrespres.bmj.com/content/8/1/e000956.abstract N2 - Background Despite advances in cystic fibrosis (CF) management and survival, the optimal treatment of pulmonary exacerbations remains unclear. Understanding the variability in treatment approaches among physicians might help prioritise clinical uncertainties to address through clinical trials.Methods Physicians from Australia and New Zealand who care for people with CF were invited to participate in a web survey of treatment preferences for CF pulmonary exacerbations. Six typical clinical scenarios were presented; three to paediatric and another three to adult physicians. For each scenario, physicians were asked to choose treatment options and provide reasons for their choices.Results Forty-nine CF physicians (31 paediatric and 18 adult medicine) participated; more than half reported 10+ years of experience. There was considerable variation in primary antibiotic selection; none was preferred by more than half of respondents in any scenario. For secondary antibiotic therapy, respondents consistently preferred intravenous tobramycin and a third antibiotic was rarely prescribed, except in one scenario describing an adult patient. Hypertonic saline nebulisation and twice daily chest physiotherapy was preferred in most scenarios while dornase alfa use was more variable. Most CF physicians (>80%) preferred to change therapy if there was no early response. Professional opinion was the most common reason for antibiotic choice.Conclusions Variation exists among CF physicians in their preferred choice of primary antibiotic and use of dornase alfa. These preferences are driven by professional opinion, possibly reflecting a lack of evidence to base policy recommendations. Evidence from high-quality clinical trials is needed to inform physician decision making.Data are available on reasonable request. Summary-level trial results will be shared, and individual participant data can be requested subject to necessary HREC approvals. As a minimum, data sharing will include deidentified participant data including survey type and responses to case scenarios. Individual responses to open text answers have been included in online supplemental material. ER -