The number of adults with cystic fibrosis (CF) equals or exceeds that of children in many parts of the world. Consequently the size and number of adult centres has grown. In association with these increased numbers, the complexity of care of the adult has also increased. Emerging complications are commonplace and include diabetes, drug allergy and toxicity, difficulties with venous access and multiresistant infections. Strategies to enhance self-management require further evaluation in the setting of therapy requirements, which are increasingly complex. Planning for the provision of facilities and resources for the care of adults with CF, including training of multidisciplinary healthcare members, has been variable within and between countries. Novel models for the delivery of adult CF care may provide the opportunity to continue to deliver effective management to a rapidly growing population.