Background Improved understanding and treatment of cystic fibrosis (CF) has led to longer life expectancy, which is accompanied by an increasingly complex regimen of treatments.Suboptimal adherence to the treatment plan, in the context of respiratory disease, has been found to be associated with poorer health outcomes. With digital technology being more accessible, it can be used to monitor adherence to inhaled therapies via chipped nebulisers, mobile phone apps and web-based platforms. This technology can allow monitoring of adherence as well as clinical outcomes, and allow feedback to both the person with CF and their healthcare team. Objectives To assess the eDects of using digital technology to monitor adherence to inhaled therapies and health status in adults and children with CF. Search methods We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 28 October 2021. We also searched Embase and three clinical trial registries and checked references of included studies. Date of last search: 9 November 2021. Selection criteria We searched for randomised controlled trials (RCTs) looking at the eDects of a digital technology for monitoring adherence of children and adults with CF to inhaled therapies. Data collection and analysis Two review authors screened the search results for studies eligible for inclusion in the review and extracted their data. We used Risk of Bias 2 for assessing study quality. We assessed the overall certainty of the evidence using GRADE. Main results We included two studies in our review, with 628 participants aged five to 41 years. There was one study each for two diDerent comparisons.The included parallel study was carried out over 10 weeks aKer a run-in period of four to six weeks. The study compared the eDects of a digitally enhanced inhalation mode (target inhalation mode) for nebulised antibiotics compared to standard mode in children attending a regional CF clinic in the United Kingdom. The study's primary outcome was the time taken to complete the inhaled treatment, but investigators also reported on adherence to therapy. The results showed that there may be an improvement in adherence with the target inhalation mode when this intervention is used (mean diDerence (MD) 24.0%, 95% confidence interval (CI) 2.95 to 45.05; lowcertainty evidence). The target inhalation mode may make little or no diDerence to forced expiratory volume in one second (FEV1) % predicted (MD 1.00 % predicted, 95% CI -9.37 to 11.37; low-certainty evidence). The study did not report on treatment burden, quality of life (QoL) or pulmonary exacerbations.
