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This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate whether digital technology can effectively predict pulmonary exacerbations to allow earlier intervention and improved health outcomes without increasing the burden of treatment in people with cystic fibrosis (CF).

Poor adherence is a global health issue, affecting all chronic conditions and all age groups. Medications will only work if they are taken, and ongoing adherence to medication and treatment is difficult in chronic illness. Average adherence rates are approximately 50% in paediatric patients with asthma, and this can lead to poor disease control and an increase in morbidity. Thus, it is prudent to consider and discuss non-adherence, whether it be intentional or unintentional, to avoid unnecessary escalation of treatment. In this review, we discuss the fundamentals of adherence and the importance of goal setting. We discuss the challenges in varying age-groups, and methods that can be incorporated in various settings to optimize adherence. We explore how the advent of e-health (the combination of healthcare and technology) has impacted upon our ability to monitor adherence.

Post infectious obliterative bronchiolitis (PIBO) is an unusual and rare complication of lower respiratory tract infections in children, with Adenovirus being the most common cause. The condition is non progressive and treatments mostly supportive. Little is known about the respiratory morbidity from frequent exacerbations of respiratory symptoms. Methods: We describe the frequency and symptoms during exacerbation in a cohort of 12 patients for a mean 2.6 years after diagnosis. Diagnosis of PIBO was based on CT findings together with a suggestive clinical course. The exacerbations were classified as wheezy or infective based on the predominant symptom. Data on the types of symptoms and treatments given were collected. Results: Median age at diagnosis was 2 yrs 4 months. Most cases were post infective (80%) and the most common aetiologic agents were Adenovirus (60%), Rhinovirus (40%) and RSV (30%). Most patients were managed on long term anti-inflammatory therapy with Azithromycin and inhaled steroids. 5 patients were on home oxygen. The mean time between outpatient follow-up was 3 months. There was significant variability in the number of exacerbations ranging between 0 to 4 per year. Most children had infective exacerbations which did not usually lead to hospitalisation. Most were treated with oral antibiotics usually Co-amoxiclav. In the same individual the exacerbations are usually of the same types. Conclusion: There is considerable heterogeneity in the presentation of children with exacerbations. These may correlate with the extent of bronchiectasis radiologically. Outcomes could be improved by proactive antibiotic treatment if such a correlation can be studied in a larger cohort using a national database.