Study Results May be Influenced by Pulmonary Function and Improved Drug Compliance

Patrick A^*
*Correspondence: Patrick A, Department of Pulmonary, University of Washington School of Medicine, Seattle, Washington, USA, Email:

Introduction

The research that was included revealed two intriguing results. First, although it is not yet apparent how this is achieved, various studies have noted a decrease in the incidence of air leaks. This may be a result of the PET program's effects on the respiratory muscles, but it may also be a function of the operating method that was used. Second, the impacts on spirometric variables produced mixed results. Three studies did not find an improvement in pulmonary function, although two studies found an increase in those measures after a PET programme. However, increased medication adherence may be the cause of the apparent improvement in some studies. In our opinion, the PET programme does not directly affect pulmonary function. Yet, only the study noted that quitting smoking and The PET programme included pharmaceutical therapy optimization; however the results showed no appreciable change in pulmonary function. An improvement in the patient's spirometer technique could be one explanation. Although there is encouraging evidence for the effectiveness of PET, there are currently three issues with how the trials were evaluated: Patient populations with a variety of characteristics, incomparable PET regimens, and a lack of documented outcome measurements are the first two of these problems.

Comparisons were challenging due to the variability of the evaluated PET programmes, and the included studies in this systematic review did not clearly state what the best exercise regimens for this patient population should be. Another consideration is the scheduling of the procedure. Due to the time constraints and physical conditions of the patient in each location, preoperative exercise and postoperative exercise should be viewed as distinct entities. The expected PET programme was too long, and medical experts were unwilling to postpone the surgery date because of the limited preoperative time period, PET programmes were shorter in duration and more rigorous in prescribed sessions a week. Research looking into postoperative exercise regimens spans a significantly wider time frame. For individuals who are moderately unfit, a shorter exercise regimen with more frequent workouts can be problematic. According to a study by Jones and colleagues, their brief but vigorous exercise regimen may have made them feel more exhausted.

Adherence to medications is often suboptimal among patients with chronic diseases like Cystic Fibrosis (CF). Data from electronic medication monitoring devices and from analysis of prescription refill histories reveal adherence rates of 30-75% among individuals with Adolescents have significantly lower rates of medication adherence compared to other age groups 2,3,5,8. Prescription refill data over a five-year period revealed adherence rates of 46-65% to pancreatic enzymes, vitamins, inhaled hypertonic saline and dornase alfa among patients with CF 13-21 years of age. The same study showed adherence rates of 73-83% among those 0-5 years of age 2. A different study evaluated adherence using electronic pill caps and also found lower rates of adherence to vitamins among adolescents compared to those less than 12 years of age (57% vs. 85%).

Description

Individuals with CF have a high clinical, psychosocial and economic burden that is compounded in the setting of non-adherence. Adolescents are particularly vulnerable since there is a significant decline in Pulmonary Function (PFT) that occurs during this time. An important risk factor for this reduction in PFT is having frequent pulmonary exacerbations, a factor that has been linked to poor medication adherence. Poor nutritional status is another risk factor for worsening PFTs among children and adolescents with CF. Those who demonstrate good medication adherence have also been noted to have better weight gain and higher Body Mass Indices (BMI) irrespective of their age. Barriers to medication adherence among adolescents with CF include forgetfulness, competing time pressures, and doubts about the necessity or usefulness of the prescribed treatment regimen. There is a decline in parental supervision during adolescence, which has been shown to negatively impact treatment adherence in this group.

Knowledge about the disease which is often deficient among adolescents has also been shown to influence adherence. With worsening disease severity, the complexity of the prescribed treatment regimen increases in patients with CF. More treatments are added in an effort to slow down the progression of the disease. This escalation in treatment complexity has been shown to adversely affect perceptions of treatment burden, with the effects being more pronounced amongst adolescents. Having a high perception of treatment burden can negatively impact selfmanagement skills and lower adherence.

Many of the same studies that elicited the aforementioned barriers have also identified multiple adherence motivators such as recognition of the impact of non-adherence on health outcomes, a strong relationship with the CF care team and encouragement from friends and family. Interventions that promote self-management skills, whether they are a knowledge-based intervention such as providing more education about the disease process and available treatments, or a behavioral intervention like motivational interviewing, appear to improve medication adherence in individuals with CF. The use of technology to promote self-management skills and adherence is becoming increasingly popular 30-35.

Medication reminders have been successful in enabling patients with CF to take ownership of their disease and have resulted in improved adherence. However, very little data exists on the impact of these interventions on the already high perceptions of treatment burden. Reviewing PFT results appear to be an adherence motivator for many adolescents and young adults. Home PFT monitoring has enabled clinicians to obtain more frequent data and allows patients the opportunity to readily review and keep track of the results.

Lechtzin et al conducted a large, randomized controlled trial evaluating the benefits of early detection of pulmonary exacerbations on PFT in adults with CF. Participants assigned to the intervention arm were asked to measure their PFTs and fill out an online respiratory symptom diary twice a week from home for one-year duration. Both of these were viewed in real time by an electronic monitoring system.

Conclusion

Any new symptoms or significant declines in PFT were identified as potential pulmonary exacerbations and immediately reported to the care team so an acute/sick clinic visit could be scheduled. In contrast, participants in the usual care arm were asked to call the clinic with symptoms and schedule acute/sick visits as needed for potential exacerbations.