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Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study

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Abstract

Background Nebulised medicines contribute to the high treatment burden experienced by patients with cystic fibrosis (CF). Objectives This study explored experiences of adult patients with CF when using nebulised medicines, factors impacting on their adherence to nebulised therapy and strategies they used to facilitate adherence. Setting Community setting, in Sydney, Australia. Methods Ten patients with CF were recruited through a CF patient organisation. Semi-structured face-to-face interviews were conducted, addressing the study objectives. Interviews were audio-recorded, transcribed verbatim and content analysed for anticipated and emergent themes. Main outcome measure Experiences with using nebulised medicines; and barriers and facilitators of adherence to nebulised medicines. Results Participants’ age ranged from 22 to 45 years, with half being male. Four broad themes (with more specific sub-themes) were identified from the interviews: experiences with using nebulised medicines (cleaning nebuliser, time taken to use nebuliser medicine, flexibility in use of nebuliser); feelings about using nebulised medicines (necessary/important, dislike, part of life); factors impacting non-adherence (time consuming therapy, side effects/effects of medicine, work/social demands, lack of perceived importance); factors and strategies facilitating adherence (perceived medicine importance, habit/routine, support, health benefits, technology/medicine dose form, timetabling). Conclusions Nebulised therapy for cystic fibrosis patients takes a substantial amount of time, with patients trying to alter their routine to incorporate nebulising into their daily lives. However there are still many factors that lead to low adherence, including work/social demands and travelling. Patients balance the necessity for nebulised therapy against the barriers, and engage in intentional non-adherence at times. Future strategies and resources should target and address specific factors identified by patients with CF as being important and impacting their adherence to nebulised medicines.

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Acknowledgments

The authors acknowledge and thank the individuals that gave their time to be interviewed for this study, and the staff of Cystic Fibrosis New South Wales, in particular Alex Huntir and Miraa Best, for assistance with recruiting the participants.

Funding

Study participant’s travel costs were reimbursed by Novartis Pharmaceuticals Australia.

Conflicts of interest

AH, J-AB and PA have no conflicts of interest to declare. MB and RK are employees of Novartis Pharmaceuticals Australia; Novartis is the manufacturer of two forms of inhaled tobramycin for patients with cystic fibrosis.

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Authors and Affiliations

  1. Faculty of Pharmacy, Pharmacy and Bank Building A15, The University of Sydney, Broadway, NSW, 2006, Australia

    Alice Hogan, Jo-anne Brien & Parisa Aslani

  2. Novartis Pharmaceuticals Australia, 54 Waterloo Road, North Ryde, NSW, 2113, Australia

    Mary-Ann Bonney & Rita Karamy

  3. St Vincent’s Hospital Clinical School (UNSW), St Vincent’s Hospital, Darlinghurst, NSW, 2010, Australia

    Jo-anne Brien

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  1. Alice Hogan
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  2. Mary-Ann Bonney
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  4. Rita Karamy
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  5. Parisa Aslani
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Correspondence to Parisa Aslani.

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Hogan, A., Bonney, MA., Brien, Ja. et al. Factors affecting nebulised medicine adherence in adult patients with cystic fibrosis: a qualitative study. Int J Clin Pharm 37, 86–93 (2015). https://doi.org/10.1007/s11096-014-0043-6

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  • DOI: https://doi.org/10.1007/s11096-014-0043-6

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