TOPLINE

Habit formation was one of the strongest factors associated with adherence to inhaled medicines among adults with cystic fibrosis in the elexacaftor/tezacaftor/ivacaftor (ETI) era. Additionally, age, socioeconomic status, neurodivergence, and regimen complexity were also independently linked.

METHODOLOGY

• Researchers conducted a cross‑sectional observational study using electronically captured nebuliser data to identify factors associated with adherence to inhaled medicines among adults with cystic fibrosis in the ETI period.
• They included 214 individuals aged 16 years or older who were eligible for inhaled therapy at a UK adult cystic fibrosis centre between July 2023 and August 2024.
• Overall, 25 factors were assessed across four categories: demographic, socioeconomic, health-related, and treatment-specific psychological factors including habit formation, which was ranked from 1-5 on a Likert scale (with 1 indicating “strongly disagree” and 5 indicating “strongly agree").
• The outcome was mean daily percent adherence to inhaled medicines over 12 months, with missing adherence data conservatively imputed.
• Adherence data were classified as complete (covering all 12 months), incomplete (> 3 months within the 12-month study period), or missing (no adherence data across either 12-month period).

TAKEAWAY

• Individuals with the strongest habit of taking inhaled medicines had a mean adherence of 41.7% compared with 11.7% in those with low/absent habit. Each one-level increase in habit score was associated with a 9.73 percentage point increase in adherence (P < .001).
• Likewise, higher socioeconomic status was linked to increased adherence, with each one-level increase in socioeconomic status associated with a 2.85 percentage point increase in adherence (P = .020).
• Adults aged 16-18 years had significantly lower adherence than those in the 19- to 25-year reference group (-15.88 percentage points; P = .011).
• Likewise, complex treatment regimen (> 3 prescribed doses per day, P = .014) and neurodivergence were also associated with higher adherence.

IN PRACTICE

“Habit formation may continue to support adherence among adults on ETI and may also benefit ‘the 10%’ who are ineligible for ETI or other CFTRm [cystic fibrosis transmembrane conductance regulatory protein modulator] therapy,” the authors wrote.

SOURCE

The study was led by Robert David Sandler, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England. It was published online on May 28, 2026, in Journal of Cystic Fibrosis.

LIMITATIONS

Treatment-specific psychological factors were assessed using single-item questions completed, risking measurement error and social‑desirability bias. The cross‑sectional design limits generalizability. Routinely collected health data depend on accurate coding; neurodivergence is often underrecorded because of barriers to diagnostic services.

DISCLOSURES

No funding was reported for the study. One author disclosed being a sponsored delegate at conferences by Lilly and UCB, and receiving an educational bursary supported by Chiesi and the European Cystic Fibrosis Charity.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.