Effect of telemonitoring on adherence to inhalation therapy and pulmonary exacerbations in people with cystic fibrosis (conneCT CF): a multicenter randomized controlled trial
In brief
Telemonitoring raised cystic fibrosis inhaler adherence to 49% but did not delay exacerbations
In this 296-person randomized trial, people using telemonitoring and coaching had higher inhaler adherence than those receiving standard care: 49% versus 33% in the final six months. But the intervention did not extend time to the first pulmonary exacerbation; the link between better adherence and lower exacerbation risk was an association, not proof that telemonitoring prevents flare-ups.
- Journal
- Annals of the American Thoracic Society (Q1)
- Published
- 28 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Stephanie Thee, Mirjam Stahl, Sivagurunathan Sutharsan, Rainald Fischer, Manfred Ballmann, Svenja Straßburg, et al.
- PMID
- 42949105
- DOI
- 10.1093/annalsats/aaoag328
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 8 November 2026): Telemonitoring improves inhalation adherence in cystic fibrosis
Abstract
RATIONALE: Recurrent pulmonary exacerbations contribute substantially to lung function decline in people with cystic fibrosis (CF). Inhalation therapies are a cornerstone of standard of care, yet adherence to inhalation therapies is variable and data on the relationship between adherence and pulmonary exacerbations remain limited. OBJECTIVES: To assess the impact of multimodal telemonitoring and coaching on adherence and pulmonary exacerbations in people with CF. METHODS: In this prospective, multicenter, unblinded, randomized, controlled trial people with CF aged ≥12 years were randomized (1:1) to either standard of care or an intervention involving continuous objective home monitoring of inhalation adherence, weekly home spirometry, a self-management app, professional telephone coaching, and optional video conferencing over 18 months. The primary endpoint was time to first pulmonary exacerbation. MEASUREMENTS AND MAIN RESULTS: 296 participants were included with a mean age of 31.3 (SD 10.8) years, 54.1% females, mean FEV1% predicted of 70.2% (SD 24.7), 52.7% chronically infected with Pseudomonas aeruginosa, and 85.1% on triple CFTR modulator therapy. Baseline adherence was higher in the intervention group (58.1%) than in the control group (44.0%) and remained higher throughout the study (last 6 months: 49.2% vs. 32.6%). Time to first exacerbation did not differ between groups. However, across all participants, a 10% increase in adherence correlated with a 9% reduction in pulmonary exacerbation risk. Participants with FEV1<40% had a 2.4-fold higher risk of exacerbations. CONCLUSION: Multimodal telemedicine improved inhalation therapy adherence. The association between higher adherence and reduced exacerbations highlights the ongoing importance of inhalation therapy in CF, even with widespread CFTR modulator use. Clinical trial registered with German Clinical Trials Register (DRKS00024642).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.