Determinants of Long-Term Persistence with Tiotropium Bromide for Chronic Obstructive Pulmonary Disease

Abstract

Tiotropium bromide, a long-acting anticholinergic agent, improves pulmonary function and quality of life of patients suffering from chronic obstructive pulmonary disease (COPD). We retrospectively examined the factors that determine the long-term persistence with tiotropium bromide. Among 6,301 patients who underwent pulmonary function tests in our pulmonary clinic between 2006 and 2009, 644 met the following criteria: 1) age > 40 years, 2) ≥ 20 pack-years smoking history, and 3) forced expiratory volume in 1 sec / forced vital capacity ratio < 0.7. The clinical information, including the prescription of tiotropium, was obtained from the patients' records. Tiotropium was administered to 255 patients (40%), of whom 48 (19%) discontinued treatment within 1 year, and 65 (25%) discontinued treatment within the median observation period of 32 months. The drug was discontinued because of ineffectiveness in 35 patients (73%), and because of adverse drug effects in 13 patients (27%). Young age, current smoking, absence of respiratory symptoms alleviation, and less severe disease characterized by a) mild airflow limitation, b) mild to moderate emphysema, or c) no exacerbation of COPD during the 1(st) year of treatment were predictors of drug discontinuation.

Barriers and Strategies for Improving Medication Adherence Among People Living With COPD: A Systematic Review

“…Seven studies performed sensitivity analyses to measure the robustness of the statistical methods used. 28,38,40,41,43,45,57 Furthermore, only 6 studies clarified the results of included subjects with a flow diagram. 31,33,38,[40][41][42] Among the included studies, 8 studies noted potential sources of bias.…”

“…= 13), 13,29,[42][43][44][45][46][47][48][49][50][51] Asia (no. = 8), 29,[52][53][54][55][56][57][58] Australia (no. = 2), 59,60 Africa (no.…”

“…= 1); one study did not assess adherence. 57 Several scales without specific names (no. = 6) 36,37,49,54,56,61 were the most frequently used self-report measure followed by the Medication Adherence Report Scale (no.…”

“…55 In 12 studies, 13,27,32,34,36,38,39,[41][42][43]51,60 subjects were using either monotherapy (long-acting b 2 agonist [LABA], longacting muscarinic antagonist [LAMA], or inhaled corticosteroid [ICS]) or dual therapy (ICS/LABA or LABA/LAMA); in 3 studies, subjects were using either monotherapy, dual therapy, or triple therapy (ie, ICS/LABA/LAMA), 31,45,54 and in 1 study subjects were using only triple therapy. 50 Two studies reported that subjects were using only monotherapy (ie, LABA or LAMA 35,57 and another study reported that subjects were using only dual therapy (ie, ICS/LABA). 33 The other 19 studies did not mention the types of therapies that subjects were using.…”

“…43,44 Subjects from 12 of the 38 studies were using their COPD medication for $ 12 months 29,31,33,34,36,41,43,44,49,50,52,60 ; in 3 studies subjects were using their COPD medication for < 12 months, 35,48,51 and 2 studies had both newly prescribed (ie, medicine users for < 12 months) and prevalent users as subjects (medicine user for $ 12 months). 32,57 Copyright (C) 2020 Daedalus Enterprises ePub ahead of print papers have been peer-reviewed, accepted for publication, copy edited and proofread. However, this version may differ from the final published version in the online and print editions of RESPIRATORY CARE Copyright (C) 2020 Daedalus Enterprises ePub ahead of print papers have been peer-reviewed, accepted for publication, copy edited and proofread.…”