Addressing the Impact and Unmet Needs of Nonadherence in Asthma and Chronic Obstructive Pulmonary Disease: Where Do We Go From Here?

Abstract

Nonadherence to treatment, and its associated health and economic burden, is particularly problematic in asthma and chronic obstructive pulmonary disease management because of heterogeneous patient populations and the need for an inhaled route of drug administration. Symptom variability, comorbidities, and device switching further add to suboptimal adherence rates. As opposed to controlled clinical trials, real-life studies show consistently low inhaler adherence in daily practice, yet exact adherence rates have long been affected by disagreement on standardized definitions. The recently developed Ascertaining Barriers to Compliance taxonomy helps to address adherence research disparities by identifying 3 phases of adherence (initiation, implementation [including correct inhaler technique], and discontinuation). This review considers the reasons for and impact of suboptimal adherence, together with summaries of key studies that demonstrate how improving adherence can reduce exacerbations, inhaled corticosteroid use (in cases of better inhaler technique), hospitalizations, and treatment costs. Strategies to help ensure optimal adherence are discussed, including the choice of a patient-tailored inhaler, patient empowerment, education and training, and the potential of electronic monitoring and digital technology. It is concluded that a combined effort from payers, health care professionals, and manufacturers could make a real difference to asthma and chronic obstructive pulmonary disease control, as well as to health care budgets.

Real‐life effectiveness of inhaler device switch from dry powder inhalers to pressurized metred‐dose inhalers in patients with asthma treated with ICS/LABA

“…Classic randomized control trials investigating the efficacy of inhaler devices tend to enrol very selective groups of patients . In real‐life practice setting, factors such as imperfect inhalation techniques and non‐adherence to treatment are common, negatively impacting inhaler treatment outcomes . The current study indicated that within Korean real‐life practice setting, pMDI was comparable to DPI in preventing asthma exacerbations, and led to better asthma control, despite the potential for imperfect adherence and inhaler technique.…”

“…11,17,18 In real-life practice setting, factors such as imperfect inhalation techniques and non-adherence to treatment are common, [18][19][20][21][22] × strength Categorized as 0, >0 to ≤250, >250 to ≤500, >500 μg daily ICS dosage (low, medium and high as per GINA guidelines) Oral thrush Diagnostic code for oral thrush OR Prescription of antifungal therapy negatively impacting inhaler treatment outcomes. 17,[22][23][24][25] The current study indicated that within Korean real-life practice setting, pMDI was comparable to DPI in preventing asthma exacerbations, and led to better asthma control, despite the potential for imperfect adherence and inhaler technique. In addition, while this study was retrospective in nature, data were collected prospectively and thus the patients were not influenced by recall bias.…”

Inhaler Review in Older Adults with Asthma or COPD: A Cost‐Effectiveness Study and a Perspective in Portugal

“…Also, improving adherence seems to be related to decreased exacerbation risk that may be independent of inhaler technique performance . Adherence may also be an important aspect to consider in terms of cost estimation because it also affects medication costs . Here, medication costs were not considered as a subset, although cost estimations included them in the main source.…”

“…3,41,42 Adherence may also be an important aspect to consider in terms of cost estimation because it also affects medication costs. 43 Here, medication costs were not considered as a subset, although cost estimations included them in the main source. Medication costs may decrease due to better inhaler technique because as clinical control improves, other concurrent therapies are needed less often (such as oral corticosteroids or antibiotics), and the optimal inhaled dosing may also be reduced.…”

Is there room for further innovation in inhaled therapy for airways disease?

“…This can partly be explained by two key challenges facing healthcare professionals and caregivers. These are incorrect inhaler use [16] and poor patient adherence to treatment [17]. The former can be addressed by appropriate and consistent training by the healthcare professionals.…”