Adherence to airway clearance therapies by adult cystic fibrosis patients.
BACKGROUND
Airway clearance therapy (ACT) is critical in cystic fibrosis (CF).


OBJECTIVE
To determine rates of self-reported adherence to ACT by patients treated in an adult CF program, to identify patient characteristics associated with poor adherence, to typify adherence according to ACT technique, and to indicate reasons for poor adherence.


METHODS
Our cross-sectional study included CF subjects age 16 years and older. Enrollees were evaluated via general structured questionnaire, adherence questionnaire, clinical assessment, spirometry, and S(pO(2)) values. Each was stratified by self-reporting protocol as high, moderate, or poor adherence to ACT. Concordance between physiotherapist recommended ACT technique and self-reported subject adherence was subjected to agreement analysis.


RESULTS
Of the 63 subjects studied, 38 (60%) qualified as high adherence, 12 (19%) as moderate adherence, and 13 (21%) as poor adherence. Logistic regression identified education level (less than high school) as an independent factor associated with poor adherence (odds ratio 10.2, 95% CI 1.23-84.7, P = .03). Positive expiratory pressure (κ = 0.87) and flutter device (κ = 0.63) usage both corresponded with a high level of agreement, while active cycle of breathing technique (κ = 0.40) and autogenic drainage (κ = 0.39) each showed moderate agreement. Agreement was low for percussion and postural drainage (κ = 0.23). Reasons given most frequently for poor adherence to ACT were "not enough time to do ACT" (28%), "cannot be bothered" (16%), and "do not enjoy ACT technique" (8%). Many (32%) provided no reason.


CONCLUSIONS
Study outcomes showed a high rate of ACT adherence in adult CF subjects. Lower level of education was the most important factor in poor adherence to ACT. Self-reported adherence and treatment recommendations were in best agreement with positive expiratory pressure and flutter device techniques.
Faculdade de Fisioterapia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. josiflores@hotmail.com
Josani Silva
JS
Flores
Fernanda Ângela
FÂ
Teixeira
Paula Maria Eidt
PM
Rovedder
Bruna
B
Ziegler
Paulo de Tarso Roth
Pde T
Dalcin
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000523:psychology / Q000628:therapy*; D015916:Drainage, Postural; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D010474:Percussion; D057566:Self Report; D013997:Time Factors; D055815:Young Adult