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There is variability in adherence to dornase alpha in adults with CF and patient self-reporting is likely to over-estimate drug collection from the pharmacy. Further study of the long-term effects of dornase alpha is required. To date, proven interventions to enhance adherence are limited and require investigation in CF.

Background Adults with cystic fibrosis (CF) have been reported to be at five to ten-fold risk (25 to 30 fold risk after solid organ transplant) of colorectal cancer (CRC) than the general population. Limited publications to date have reported on practical aspects of achieving adequate colonic cleanse producing good visualisation. In this study, we compared two bowel preparation regimens, standard bowel preparation and a modified CF bowel preparation. Methods A non-randomised study of adults with CF attending a single centre, requiring colonoscopy investigation were selected. Between 2001 and 2015, 485 adults with CF attended the clinic; 70 adults with CF had an initial colonoscopy procedure. After five exclusions, standard bowel preparation was prescribed for 27 patients, and modified CF bowel preparation for 38 patients. Demographic and clinical data were collected for all consenting patients. Results There was a significant difference between modified CF bowel preparation group and standard bowel preparation group in bowel visualisation outcomes, with the modified CF bowel preparation group having a higher proportion of “excellent/good” GI visualisation cleanse (50.0% versus 25.9%) and lower rates of “poor” visualisation cleanse (10.5% versus 44.5%) than standard bowel preparation ( p = 0.006). Rates of “fair” GI cleanse visualisation were similar between the two groups (39.4% versus 29.6%) (Additional file 1 : Table S1). Detection rates of adenomatous polyps at initial colonoscopy was higher in modified CF bowel preparation cohort than with standard preparation group (50.0% versus 18.5%, p < 0.01). Positive adenomatous polyp detection rate in patient’s age > 40 years of age was higher (62.5%) than those < 40 years of age (24.3%) ( p = 0.003). Colonic adenocarcinoma diagnosis was similar in both groups. Conclusion This study primarily highlights that standard colonoscopy bowel preparation is often inadequate in patients with CF, and that colonic lavage using modified CF bowel preparation is required to obtain good colonic visualisation. A higher rate of polyps in patients over 40 years of age (versus less than 40 years) was evident. These results support adults with CF considered for colonoscopy screening at 40 years of age, or prior to this if symptomatic; which is earlier than CRC screening in the non-CF Australian population. Electronic supplementary material The online version of this article (10.1186/s12876-019-0979-z) contains supplementary material, which is available to authorized users.

Neville and Higgins in their review of the provision of asthma care in a recent issue of Thorax 1 refer to a meeting at the Royal College of Physicians in London at which agreement on the form of three key questions about patients' asthma symptoms was reached. The form of the questions was wrongly quoted in their paper and the correct form is: "In the last week/month: (1) Have you had diYculty sleeping because of your asthma symptoms (including cough)?(2) Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)?(3) Has your asthma interfered with your usual activities (e.g. housework, work/ school)?"There is a trade oV to be made between the better recall of events over the past week and the greater generalisability of events over the past month. The feeling of the meeting was that there was insuYcient evidence upon which to base a decision about the best timescale and further evaluation of this issue is needed. It was agreed that these questions should be answerable by simple yes/no responses, with the possibility of scaled responses where these were positive. The full proceedings have now been published by the Royal College of Physicians. 2 We hope that these questions will become a common currency for recording the outcome for patients with asthma in both primary and secondary care and would encourage their use in order that comparable data may be available in the future. Ways of incorporating the questions into general practice software are currently being explored.