The need for specialist adult CF centres is a reflection of the great advances that have been made in CF care over the last 40 years, and is a reminder that there are now more adults than children with Cystic Fibrosis. Many complications such as diabetes, bone disease and the need for lung transplantation are much more common in adults and the teams that work in adult CF centres have had to develop different skills to their paediatric colleagues. The move from a specialist paediatric to an adult CF service is an essential part of growing up and ensuring that someone with CF continues to receive the best treatment for his or her problems as they get older.

Transition to adult care also involves a change in the responsibility for care, with the young person taking charge of their routine treatments, managing problems and learning independence. This will then help to equip them with the skills to manage adult life and fully enjoy activities such as employment, going away to college or living with a partner.

The process of transition should happen over a number of years and in that time, several things need to occur. The paediatric team should outline what the timetable of transition involves, including when the last paediatric clinic or admission will take place. This is usually between the ages of 16-18 years, but varies in different centres. Teenagers should be encouraged to participate in their care from an early age - for instance, they start to see the team members in clinic on their own for the first part of the consultation. They should be involved in all decisions about treatment.

Information about the adult centre will be available through the paediatric service, and if there is a choice of several centres to attend then it should be possible to meet the teams at each, and visit the facilities early on. In this way, the most appropriate centre can be selected and uncertainty minimised. The adult team will be able to answer questions about the things that may be causing worry, for instance who will flush a port or change a button at home; how are home IV antibiotics organised? The paediatric team should prepare a 'transition document' for the adult team about each young person, summarising important clinical details. The individual concerned should also be able to make their own contribution to this document, about issues they feel are important to their ongoing care.

Specialist CF Centre care is recommended for all adults with CF by the CF Trust Consensus Standards of Care document. The option of seeing an adult respiratory physician at a local district general hospital may appear more attractive than travelling to the specialist adult CF centre, especially if paediatric care has been received locally at a shared care clinic. It is unlikely, however, that the local consultant will have the experience of the full range of current CF care and treatment. It is also unlikely that the local district general hospital will have a full multidisciplinary team that can provide the specialist nursing, physiotherapy and dietetic input that is essential to deliver proper and safe CF care. The adult CF centre, on the other hand, will have a specialist team dedicated to ensuring that young people continue to receive optimal care.

Finally, the approach of the adult and paediatric teams can seem to differ significantly in the way that they deal with a person with CF, but ultimately they work towards the same goal, which is the continued optimal health of those that they care for.

This article was written by Dr Hilary Wyatt, Consultant in Cystic Fibrosis at King's College Hospital, London.

You can read and download our three factsheets on transition of care (for parents, youngsters with CF and commisioners and clinical teams) from our Publications Library.