436 Adherence to airway clearance therapies in patients with Cystic Fibrosis

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436 Adherence to airway clearance therapies in patients with Cystic Fibrosis
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  10. Nursing Psychosocial issues [~ Psychosocial aspects of Turkish CF patients G. Cinel, D. Dogru, E. Yalcin, N. Cobanoglu, S. Pekcan, U. Ozcelik, B. Ulus, N. Kiper. Pediatric Pulmonology Unit, Hacettepe University Medical School, Ankara, Turkey As cystic fibrosis (CF) is an incurable disease, it has an impact on patients, their families. These children are at greater risk of having significant emotional or behavioural problems. Family demographics also have impact on their quality of life. Aims To assess demographic measures and factors which affect psychosocial status of our patients. Methods Parents of CF children completed a questionnaire on age at diagnosis, adhering to routine visits and treatments, occupational and school problems, social activities, family structures and income, living conditions and problems with health insurance. Results Data of 85 CF patients aged between 4 and 368 months (median 84 months) were obtained. Median age at diagnosis is 4 months. 44.7 were not going to school, 41.2 were at elementary education, 3.5 attending to university. 77.9 had 4 or more routine clinic visits annually. 62.4 had problems at school. 14.1 had psychological assistance. 35.3 had social activities like sports, music, painting and dancing. One patient smoked cigarettes and 57.6 of parents smoked cigarettes at home. 30.6 didn't apply to their diet and 23.5 to physiotherapy. Their families consisted of median 4 persons; at least one person had a job and median income was E494. 18.8 of mothers and 31.8 of fathers were graduated from university, 1.2 of mothers had no formal education. 35.3 lived in rented houses and 42.4 used stoves for heating up their houses. 96.4 of patients' health expenditures were covered by government. Conclusion Cigarette smoking, noncompliance with physiotherapy and diet, and family education are problems in Turkish CF patients. Information and support should be available to patients and their parents, to assist them in coping with this chronic illness. 97 I~ review of pulmozyme use in children on Teesside F. Lindsay, F. Hampton, S. Kumar..James' Cook University Hospital, Middlesbrough, UK Background Following the Pulmozyme Early Intervention Trial (Quan et al 2001) our use of Pulmozyme in children increased. Aim To establish parents' perceptions of their child's health whilst using Pul- mozyme and to identify antibiotic use for one year before and after starting treatment. Method Children under 18 who commenced treatment within the last 5 years and who had been diagnosed at least 1 year before starting Pulmozyme were included. Routine lung function measurements were documented. During clinic visits or routine telephone contact parents were questioned regarding their child's use of Pulmozyme. Questions related to timing of administration, their perception of concordance with treatment and their child's health status. A review of the case notes identified the antibiotic treatment of exacerbations. Results Thirty six (57 ) of patients attending clinic had been prescribed Pul- mozyme. Of these 24 fitted the above criteria. Fifteen (63 ) maintained an FEV1 > 75 throughout the review. 83 of parents were questioned. Timing of Pulmozyme administration ranged from 30 minutes to 8 hours pre physiotherapy with 67 taking it immediately on return from school. Parents' and children found concordance easy and reported significant subjective benefits. Complete information on antibiotics was available for 18 patients, too few for statistical analysis. There were a median of 4 oral and 2.5 intravenous antibiotic courses before treatment and 2.5 and 2 after. Fifteen of 18 patients had a reduction in at least 1 type of antibiotic treatment. Conclusions Parents perception of their child's health status during treatment with Pulmozyme was positive. This is reflected in maintenance of FEV1 and reduction in antibiotic use. Pulmozyme is easily adapted into family routine and concordance is reportedly high in comparison to other treatments. I• Cultural restraints and barriers to physical activity for male CF adults D. Greenop, M.J. Walshaw, M.J. Ledson. Regional Adult CF Unit, The Cardiothoracic Centre, Liverpool, UK Introduction Physical exercise is seldom a solitary activity but requires the participation or presence of other people, and as a social activity it is hypothesised that it is linked to the dominant cultural discourses of health and fitness. While the social structure of femininity militates against female participation in rigorous physical exercise, such activity is more acceptable to males who have less resistance to this aspect of self-care. We aimed to explore the material, social and cultural barriers to physical activity for adult CF males. Methods Using qualitative techniques, an independent research student (DG) com- pared the attitudes to exercise of 20 male CF adults (mean age 26 [range 18 43]) with 20 females (mean age 25 [range 18 39]) who had similar lung function (group data: 5 normal FEV1, 13 mild impairment, 14 moderate and 9 severe) selected by the CF team. Results While males with mild disease were more physically active than similar females, this trend reversed with increasing disease and the ability to exercise rigorously ceased. Of the 17 participants with an FEV1 < 50 predicted (8 male), no males used public health promoting facilities, carried out housework, shopping, or went dancing, only 2 exercised through walking, and 5 did no exercise at all (for 9 females: 5, 2, 3, 2, 6, and 3 respectively). Conclusions Although this study supports the above hypothesis, it is apparent that adult CF males are influenced by cultural discourses of masculinity that may militate against participation in less rigorous physical activities such as walking. Thus, while the social construction of masculinity favours males when well, it disfavours them when unwell. The dominant masculine discourse creates a stigmatising effect (inducing insecurity/loss) for many adult males as their CF advances. • dherence to airway clearance therapies in patients with Cystic Fibrosis A.C. Modi 1 M.K. Sontag 2, J.M. Koenig 2, F.J. Accurso 2, A.L. Quittner 3 & Investigators and Coordinators of the Airway Secretion Clearance Study. 1Cincinnati Children~ Hospital Medical Center; 2University of Colorado at Denver and Health Sciences Center; 3 University of Miami, USA Airway clearance therapies (ACT) are important in clearing mucus from the lungs of patients with CE We examined adherence rates among patients randomized to three ACTs: postural drainage and percussion (PD&P), the Flutter TM and high- frequency chest wall oscillation (HFCWO). This is one arm of a multi-center study of ACT. Adherence data was collected on 130 patients, (M age 14.2yrs; 54 male; M baseline FEV1 predicted 88.2 ). Patients were stratified by age (7 12, 13 17, and over 18 yrs) and randomized to PD&P (31 ), Flutter (30 ), and HFCWO (39 ). Every 4 months patients completed a Daily Phone Diary, a computerized 24-hr recall of daily activities, including ACT adherence. We found differences in adherence after randomization for all patients using PD&P (64 ) vs. both Flutter (47 , p < 0.01) and HFCWO (54 , p < 0.10). Differences were also found between Flutter (49 ) and HWFCO (60 ) at 1-yr follow-up (p < 0.10). We found differences in adherence for adolescents after randomization, between Flutter (33 ) and PD&P (69 , p 0.03), but not HFCWO (50 ). Ad- herence for Flutter (32 ) was significantly lower than PD&P (81 , p 0.03) and HFCWO (66 , p 0.01) 1-yr later. No statistical differences were found between ACTs for children or adults. Data suggest that ACT type does not appear to affect adherence in children and adults. However, adolescents appeared to be more adherent to HFCWO and PD&P compared to Flutter, and adherence increased over time for these ACTs. Better adherence to these treatments may be related to the amount of supervision by parents of adolescents. Study supported by Hill-Rom, Inc., and the CF Foundation.
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