Objective Measures of Vest Therapy Adherence Among Pediatric Subjects With Cystic Fibrosis

BACKGROUND: Airway clearance techniques (ACTs), including high-frequency chest wall oscillation (vest therapy), are important for maintaining lung function for patients with cystic fibrosis, but daily completion of ACTs is time-consuming and cumbersome. Patient adherence is a persistent challenge, and adherence data are largely patient reported, which may reduce accuracy. To provide definitive adherence data, this study utilized a Bluetooth-enabled vest therapy system to remotely collect objective adherence data from a cohort of pediatric subjects. METHODS: Vest usage data w ere collected over a 12-month period and compared to each subject vest prescription. Because vest prescriptions are multifaceted, we developed metrics to examine adherence to the various facets (eg, daily treatment, treatments per day, treatment duration, frequency settings, and frequency and pressure settings combined) as well as an overall adherence metric. RESULTS: Among the 73 enrolled subjects, 62 (50% male, age range 2-19 y) completed the study. Among adolescent subjects age 1319 y, average adherence to daily vest therapy (44.0%) was significantly lower than that among subjects 0-6 y old (77.8%) and subjects 7-12 y old (89.5%). As more prescribed therapy components were combined into a single adherence metric, all age groups declined in mean adherence rates, with overall adherence a decreasing function of age. CONCLUSIONS: Employing new technology to remotely collect vest usage data allows for a granular examination of vest therapy adherence. While maintaining high levels of treatment adherence becomes increasingly difficult as children age, we also found substantial reductions in adherence rates among all age groups when more complex aspects of therapy prescriptions, such as frequency and pressure settings, were examined. These data illustrate areas providers and care teams can focus on to improve patient adherence to vest prescriptions.