Multi-center cohort study exploring the impact of the first U.K. COVID-19 lockdown on nebulizer use in adults with cystic fibrosis in the CFHealthHub learning health system

ABSTRACT

Background: Promoting adherence to preventative inhaled therapy in cystic fibrosis (CF) is challenging despite a clear association with better outcomes. Motivation to maintain adherence is one aspect of the complex process required for sustained behavior change. Fear is recognized as an acute motivator, and the COVID-19 pandemic created a significant fear stimulus, especially in people with underlying respiratory disease. The objective of this study was to explore changes in nebulizer use in response to the COVID-19 pandemic. Method(s) This 16-center cohort study involved more than 60% of adult CF centers in England through the CFHealthHub learning health system. CFHealthHub was established in 2015 to help promote adherence to nebulized therapy. It provides people with CF and their clinicians objective usage information through nebulizers with real-time electronic data capture capability. We explored the association between the first U.K. national lockdown (March 23, 2020, to May 28, 2020) and nebulizer use, using the mixed-effect multilevel model adjusted for potential confounders including age (fitted as a nonlinear term), sex, and deprivation index. Result(s) We included 581 adults with CF participating in CFHealthHub between September 1, 2019, and August 21, 2020. Mean age was 34;49% participants were female. The range of mean weekly nebulizations per patient increased from 9 to 12 to 12 to 14 in the week after the first U.K. national lockdown before decreasing to 11 to 12 throughout the rest of the study period (Figure 1). The association between lockdown and nebulizer Figure 1 Mean weekly nebulizations in 581 adults with cystic fibrosis at 16 U.K. centers between September 2019 and August 2020.(Figure Presented) use was attenuated after adjusting for age, sex, and deprivation index (adjusted odds ratio = 0.96, 95% CI, 0.89-1.07). Conclusion(s) We did not find a sustained change in nebulizer use in response to the firstU.K. national lockdown. This may support the assertion that behavior change with respect to sustained increased nebulizer use may not be achieved when focusing on motivational aspects, especially fear, alone Copyright © 2022, European Cystic Fibrosis Society. All rights reserved