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Background Adherence to CF treatments is poor, which can lead to negative health outcomes. The objective of our study was to qualitatively investigate the barriers and facilitators of self management among older adolescents and adults with CF. Methods Individual semi-structured interviews were conducted, audio-taped, transcribed verbatim and coded to identify common themes. Results Twenty-five patients were interviewed. Four broad themes were identified: Barriers to Self-Management (e.g., treatment burden (identified by 64% of patients), accidental or purposeful forgetting (60%), no perceived benefit (56%)), Facilitators of Self-Management (e.g., CF clinic visits (76%), social support (68%), perceived benefit (68%)), Substitution of Alternative Approaches to Conventional Management (36%) and Planned Nonadherence (32%). Conclusions Older adolescents and adults with CF identified many barriers and facilitators of adherence that may be amenable to self-management counseling strategies, particularly the use of health feedback.

To assess understanding of numerical concepts in asthma self-management instructions, a 4-item Asthma Numeracy Questionnaire (ANQ) was developed and read to 73 adults with persistent asthma. Participants completed the Short Test of Functional Health Literacy in Adults (STOFHLA), 12(16%) answered all 4 numeracy items correctly; 6(8%) answered none correctly. Participants were least likely to understand items involving risk and percentages. Low numeracy but not STOFHLA score was associated with a history of hospitalization for asthma. At higher STOFHLA levels there was a wide range of the total number of correct numeracy responses. Numeracy is a unique and important component of health literacy.

Adherence broadly encompasses the decisions patients make as to whether health care advice should be initiated, as well as the degree to which the recommended health behaviors, once started, are maintained. Disease-related conditions such as severity and duration of illness, as well as treatment-related features such as frequency of dosing and side effects, are 2 of several factors that influence adherence. Other factors affecting adherence include socioeconomic status, patient-related causes, and health system-related reasons. Adherence is rarely, if ever, an all-or-none phenomenon. Typically, patients follow some recommendations closely while deciding others are optional; these decisions are often made without consulting with or notifying health care professionals. Non-adherence can be categorized as either unintentional or intentional. Unintentional non-adherence is easier to remedy because it responds to patient education, simplification of treatment regimens, or the use of a reminder system. Intentional non-adherence is more complex and challenging to address because patients exhibiting these behaviors often do not find evidence-based recommendations compelling, lack the motivation to follow advice, or have deeply entrenched personal beliefs that conflict with health guidance. Novel psychotherapeutic behavioral interventions, such as shared decision-making, motivational interviewing, and coaching are some approaches being tested to determine their effectiveness in mitigating the resistance to treatment that characterizes intentional non-adherence in asthma and COPD populations. In this narrative review, the extent of non-adherence to asthma and COPD management recommendations is explored, the factors affecting adherence are explicated, the methods used to measure adherence are compared and contrasted, and the effectiveness of strategies targeting unintentional and intentional non-adherence is detailed.

There is growing evidence that a number of pulmonary diseases affect women differently and with a greater degree of severity than men. The causes for such sex disparity is the focus of this Blue Conference Perspective review, which explores basic cellular and molecular mechanisms, life stages, and clinical outcomes based on environmental, sociocultural, occupational, and infectious scenarios, as well as medical health beliefs. Owing to the breadth of issues related to women and lung disease, we present examples of both basic and clinical concepts that may be the cause for pulmonary disease disparity in women. These examples include those diseases that predominantly affect women, as well as the rising incidence among women for diseases traditionally occurring in men, such as chronic obstructive pulmonary disease. Sociocultural implications of pulmonary disease attributable to biomass burning and infectious diseases among women in low-to middle-income countries are reviewed, as are disparities in respiratory health among sexual minority women in high-income countries. The implications of the use of complementary and alternative medicine by women to influence respiratory disease are examined, and future directions for research on women and respiratory health are provided.