(50) Multi-center cohort study exploring the impact of the first UK COVID-19 lockdown on nebulizer usage amongst adults with cystic fibrosis, within the CFHealthHub learning health system

Background: Promoting adherence with 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 coronavirus disease-19 (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 usage in response to the COVID-19 pandemic.

Methods: This 16-center cohort study involved over 60% of adult CF centers in England, through the CFHealthHub learning health system. CFHealthHub was established in 2015 to help promote adherence with nebulized therapy. It provides people with CF and their clinicians objective usage information, through nebulizers with electronic data capture capability, in real-time. We explored the association of the first United Kingdom (UK) national lockdown (23-Mar-2020 to 28-May-2020) with nebulizer usage, using the mixed-effect multilevel model, adjusting for potential confounders including age (fitted as a non-linear term), sex and deprivation index.

Results: We included 581 adults with CF, participating in CFHealthHub between 1-Sep-2019 and 21-Aug-2020. Mean age was 34 years, with 49% being female. The range of mean weekly nebulizations per patient increased from 9-12 to 12-14 in the week following the first UK national lockdown before decreasing to 11-12 throughout the rest of the study period. The association of lockdown with nebulizer usage was attenuated after adjusting for age, sex and deprivation index (adjusted odds ratio=0.96[0.89-1.07]).

Conclusions: We did not find a sustained change in nebulizer usage in response to the first UK national lockdown. This may support the assertion that behavior change, with respect to sustained increased nebulizer usage, may not be achieved when focusing on motivational aspects, especially fear, alone.

Acknowledgements: CFHealthHub is supported by a research grant from the Cystic Fibrosis Foundation (Grant number: 00908321).

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