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Patient Prefer Adherence. 2017 May 8;11:861-869. doi: 10.2147/PPA.S123723. eCollection 2017.

Investigating the feasibility of text message reminders to improve adherence to nebulized medication in children and adolescents with cystic fibrosis.

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Cystic Fibrosis Unit, Sheffield Children's Hospital.
Academic Unit of Child Health, University of Sheffield, Sheffield, UK.



Children with cystic fibrosis (CF) often have suboptimal adherence rates to nebulized medication. Adherence barriers cited include forgetting to take the nebulizers, due to busy home and social lives. Text message reminders have been shown to be effective at improving adherence rates in other chronic diseases such as asthma and diabetes.


The objective of this study was to assess the feasibility and efficacy of sending text reminders for a prolonged period of time to children with CF.


Children with CF aged 5-16 years taking at least one medication via a nebulizer with an electronic adherence monitor were consented for the study. Text message reminders were sent to participants and/or parents via the hospital's automated text service, up to twice a day, for 6 months. The adherence rates for the 6-month text period were compared to the previous 6 months before the study. Rates were calculated for weekdays, weekends, and school holidays.


Seventeen participants were recruited to the study, with a mean age of 12 years and a mean forced expiratory volume in 1 second (FEV1) of 81% predicted. Fifteen children completed the 6-month text period, and I-neb data were accurately analyzed for 13 participants. The mean adherence rate in the 6 months receiving texts was 80%, compared to 81% in the prior 6 months. Overall adherence rates on weekdays, weekends, and school holidays were equivalent during the 2 time periods. A subgroup of patients with moderate baseline adherence showed increased adherence during the text period, particularly at weekends.


It is feasible to send text message reminders to children with CF, and they are amenable to this approach. Although text reminders do not increase rates in patients with existing optimal adherence, they may be of value in patients with more moderate baseline rates.


adherence; cystic fibrosis; telehealth

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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