Use of adjunctive digital health technology in a 35-year-old female with cystic fibrosis: A case report

View Image



Cystic fibrosis is a challenging disease state to manage as treatment regimens are complex and time-consuming. Patients may suffer from reduced quality of life due to the burden of adherence, and low adherence may affect patients’ lung function or lead to more frequent exacerbations and hospitalizations. Digital Health Technology (DHT) tools may provide support, and AmerisourceBergen has created an iPhone application called Phlo to assist patients with their treatment regimens. Phlo, along with eight smart buttons that pair to the app, integrates into the patient’s home and makes it easy to record their adherence. Data from the app is visible to the patient and healthcare team. The app shows their medication delivery schedule and allows them to set individualized goals and track quality of life over time. This case study showcases the experience of a 35-year-old female cystic fibrosis patient who was given access to this DHT for a six-month time period. Healthcare utilization, lung function, and quality of life were measured at baseline and throughout the usage period. DHT use may have contributed to modest benefits in decreasing length of hospital stay, increasing outpatient visits, improving lung function, and enhancing the patient’s overall quality of life. Further research is needed to elucidate the effects of this adjunctive DHT and show statistical significance, but it may prove to be a beneficial tool in CF management moving forward.


  1. Cystic Fibrosis Foundation. About Cystic Fibrosis. (2019, September 9). Retrieved from
  2. Kerem, B, et al., 1989, “Identification of the Cystic Fibrosis Gene: Genetic Analysis.” Science., vol. 245, no. 4922, pp. 1073–1080.
  3. Bregnballe, V., Schiøtz, Boisen, Pressler, T., & Thastum. (2011). Barriers to adherence in adolescents and young adults with cystic fibrosis: A questionnaire study in young patients and their parents. Patient Preference and Adherence,507.
  4. Eakin, M. N., Bilderback, A., Boyle, M. P., Mogayzel, P. J., & Riekert, K. A. (2011). Longitudinal association between medication adherence and lung health in people with cystic fibrosis. Journal of Cystic Fibrosis,10(4), 258-264.
  5. Quittner, A. L., Saez-Flores, E., & Barton, J. D. (2016). The psychological burden of cystic fibrosis. Current Opinion in Pulmonary Medicine,22(2), 187-191. 
  6. Llorente, R. P., García, C. B., & Martín, J. J. (2008). Treatment compliance in children and adults with Cystic Fibrosis. Journal of Cystic Fibrosis,7(5), 359-367.
  7. Goodfellow, N. A., Hawwa, A. F., Reid, A. J., Horne, R., Shields, M. D., & Mcelnay, J. C. (2015). Adherence to treatment in children and adolescents with cystic fibrosis: A cross-sectional, multi-method study investigating the influence of beliefs about treatment and parental depressive symptoms. BMC Pulmonary Medicine,15(1). 
  8. Sharma A, Harrington RA, McClellan MB, et al. Using digital health technology to Better generate evidence and Deliver evidence-based care. Published June 5, 2018.
  9. Calthorpe RJ, Smith S, Gathercole K, Smyth AR. Using digital technology for home monitoring, adherence and self-management in cystic fibrosis: A state-of-the-art review. Thorax. 2019;75(1):72-77. doi:10.1136/thoraxjnl-2019-213233.
  10. JM; HBAPGCG. Development of the Cystic Fibrosis Questionnaire (CFQ) for assessing quality of life in pediatric and adult patients. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. Published February 12, 2003.
  11. Floch, J., Zettl, A., Fricke, L., Weisser, T., Grut, L., Vilarinho, T., Schauber, C. (2018). User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach. JMIR MHealth and UHealth, 6(5).
  12. Rudolf I, Pieper K, Nolte H, et al. Assessment of a Mobile App by Adolescents and Young Adults With Cystic Fibrosis: Pilot Evaluation. JMIR mHealth and uHealth. Published November 21, 2019.
  13. Wood J, Jenkins S, Putrino D, et al. A smartphone application for reporting symptoms in adults with cystic fibrosis improves the detection of exacerbations: Results of a randomised controlled trial. Journal of Cystic Fibrosis. 2019;19(2):271-276. doi:10.1016/j.jcf.2019.09.002.
  14. Boon M, Calvo-Lerma J, Claes I, et al. Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with Cystic Fibrosis. Journal of Cystic Fibrosis. 2020;19(4):562-568. doi:10.1016/j.jcf.2020.04.001.
  15. Rutland SB, Bergquist RP, Hager A, et al. A Mobile Health Platform for Self-Management of Pediatric Cystic Fibrosis: Qualitative Study of Adaptation to Stakeholder Needs and Integration in Clinical Settings. JMIR Formative Research. Published January 26, 2021.
  16. Cazzola M, MacNee W, Martinez FJ, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers. European Respiratory Society. Published February 1, 2008.
Recommend0 recommendationsPublished in College of Pharmacy, Virtual Poster Session Spring 2021


  1. Do you know if Phlo (the app) is specific to the disease, or can it be used for other conditions? Has it been used in other studies? Thanks!

    1. Great question! Up to this point it has only been studied in cystic fibrosis patients, but I believe it could easily be used in other disease states because of how customizable it is. Patients are able to set their own goals and attach smart buttons to any activity or medication they want. Definitely could be widely used but cystic fibrosis was a good first trial since it is so complex.

  2. Very interesting project Melanie- I am curious if you collected any qualitative data from the patient about what they thought of the app? It sounds like they felt overall quality of life improved but I’m curious if they had any additional feedback?

    1. Hi Dr. Raber- great question. She did give us some qualitative feedback. Overall, she felt it was helpful in reminding her to take her medications and would be especially helpful for a patient who struggles to be adherent to their medication regimen. There were times that she said the smart button didn’t send the data to the app appropriately, but she was able to just mark it in the app. Overall, she stated it was very easy to set up and was user friendly.

  3. Melanie, Nice work and poster. I’m curious about the “role” and “weight” QOL outcomes. Is “role” the role in disease management? And weight is body weight? Any thoughts on why those two items, in particular, might have shown largest improvement?

    1. The role domain pertains to things such as work or school and how the patient feels they are able to perform in those areas or how their disease might get in the way of that. I think that giving patients a tool to manage their complex treatment regimens will help them be able to focus on the other day to day activities and responsibilities they have. Additionally, if they are adherent to their regimens, they are more likely to feel well enough to handle their responsibilities.

      The weight domain refers to body weight, specifically if patients struggle to put on weight or not, as CF can cause problems with absorbing nutrients. I believe that this tool has the potential to increase medication adherence. Several of the medications CF patients use help with absorbing and replenishing nutrients, which is likely to help them gain weight and keep it on.

      Thanks for the great question!

  4. Melanie – thank you for this interesting report!! I believe technology is such an amazing tool for so many different healthcare issues. Are other CF patients using this tool?

    1. Hi Dr. Shane-McWhorter! I totally agree with you- technology can be so helpful. If you visit San Tran’s poster you can learn some more about a cohort of 30+ patients who used this tool during the pilot study of Phlo. Hopefully one day it can be available to anyone with a smart phone.

Comments are closed.