The process of adhering to aerosol therapy in adolescents with cystic fibrosis: patient and parent perspectives

Advances in medicine and healthcare have resulted in significant improvements for those children and adolescents living with a chronic health condition. However, the treatments prescribed will only work if they are taken. Rates of adherence to treatment in cystic fibrosis are low. This is especially true for adherence to aerosol therapy, a particular concern considering the reliance on aerosol therapy for the treatment of Pseudomonas aeruginosa. The advent of Adaptive Aerosol Delivery™ (AAD) technology has enabled accurate and objective measurement of adherence to aerosol therapy treatment. However, the factors which influence the process of adhering to aerosol therapy remain largely elusive. Therefore, the current study aims to qualitatively explore the process of adhering to aerosol therapy in a clinical sample of adolescents with CF from both a patient and parent perspective. In addition, objective data downloaded from an AAD device (the I-neb™, Respironics, Chichester, UK) will be used to cue reflections on actual events around adherence. 12 participants were interviewed (six parent-child dyads). The participating adolescents were all aged between 11 and 16 years and had a CF diagnosis. There were five mothers and one father who took part. The parent and adolescent data were analysed separately using the Grounded Theory Method. Nine core categories for the parent data and nine core categories for the adolescent data were developed into a coherent framework and represented as a theoretical formulation which described the process of adhering to aerosol therapy from both a parent and adolescent patient perspective. The theoretical formulation highlights the complexity involved and details the numerous interacting biological, psychological, social and environmental influences on adherence to aerosol therapy. These findings are discussed in relation to the existing literature and clinical implications are considered. The results of the current study complement and extend previous research on adherence in CF.