Is adherence to nebuliser therapy better in teenage patients at weekends and during school holidays?
Why is this important?
Families of children with cystic fibrosis face a considerable treatment burden, something they try and cope with each and every day. Nebulised therapies make up a large part of this burden. We know from previous studies using data downloaded from the I-neb nebuliser, that adherence to these therapies varies, particularly amongst teenagers. We also know that patients are more likely to take their treatment in the evenings rather than the mornings, possibly because of time pressures in busy households. We wanted to find out whether adherence to treatment varied at different times of the week (weekends vs. weekdays) and year (holidays vs. school term-times).
What did you do?
24 adolescents on long-term nebulised therapy at two regional UK paediatric CF centres (Liverpool and Leeds) had their I-neb (nebulizer with in-built computer for recording usage) data analysed. Patients were prescribed 1-3 daily nebulised treatments including Colistin, Tobramycin and Dornase alfa. Data, including the number and dates of each treatment, were downloaded for a full school year. Adherence (% of doses taken ÷ expected number) was calculated for weekends and weekdays, term-times and holidays, for each patient.
What did you find?
Our results showed large variation in adherence between patients. We found that weekday adherence was better than weekend during term-time but not holidays. We also found that average adherence during school term-time was significantly better than holidays (particularly over Christmas). Interestingly, we observed that patients took a similar number of treatments, whether they were prescribed two or three treatments per day.
What does this mean and reasons for caution?
Overall adherence to inhaled therapies was reasonable, but significantly reduced during holiday periods. This suggests a need for families to have not only time, but also structure in their daily routine to maintain optimal adherence to long-term therapies. It may be that some adolescents and their families, either consciously or subconsciously, take treatment holidays over weekends and holiday periods. It is important for CF teams to appreciate these factors when supporting families.
We would like to explore in more detail some of the reasons why adherence varies so much between and within individuals. We would also like to use data downloaded remotely from patients nebuliser devices to identify and predict when their chests are worsening so that prompt treatment can be started.