Adherence to inhaled therapy and its impact on chronic obstructive pulmonary disease (COPD)

Humenberger, Magdalena; Hörner, Andreas; Labek, Anna; Kaiser, Bernhard; Frechinger, Rupert; Brock, Constanze; Lichtenberger, Petra; Lamprecht, Bernd

doi:10.1186/s12890-018-0724-3

Cited by 69 publications

(64 citation statements)

References 37 publications

(40 reference statements)

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“…However, in previous studies, adherence to inhaler therapy was best in patients who were 65 years or older, male, and had more severe COPD based on GOLD criteria. 6,28,33 The discrepancy between the findings of this and previous studies may be explained by the fact that most participants in this study were elderly men with mild-to-moderate COPD (GOLDⅠ-Ⅱ). Previous studies have reported that poor adherence appears in the initial year of inhalation therapy and that inhalation education improves adherence.…”

contrasting

confidence: 85%

“…6,19 It has been reported that mood disorders may affect the recognition of personal health goals and cause poor adherence. 18,27,28 The study showed a link between the HADS and ASK-20 scores, suggesting that mood disorders may increase the ASK-20 scores. In patients with high ASK-20 scores, it may be necessary to consider the possibility that mood disorders may underlie poor adherence.…”

mentioning

confidence: 92%

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The Relationship Between the “Adherence Starts with Knowledge-20” Questionnaire and Clinical Factors in Patients with COPD: A Multi-Center, Cross-Sectional Study

Akimoto

Hirai

Matsunaga

et al. 2020

COPD

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Inhaler therapy is the mainstay of chronic obstructive pulmonary disease (COPD) management. Poor adherence causes disease exacerbation and affects patient mortality. Although the Adherence Starts with Knowledge-20 (ASK-20) questionnaire is a reliable tool for assessing medication adherence, the relationship between the ASK-20 and clinical factors in patients with COPD remains unknown. We investigated the relationship between the ASK-20 and clinical factors, and assessed real-world inhaler therapy use. Patients and Methods: A multicenter, cross-sectional study of outpatients with COPD undergoing inhaler treatment who completed the ASK-20 questionnaire was performed. We investigated COPD-related health status using the COPD Assessment Test (CAT), psychological status using the Hospital Anxiety and Depression Scale (HADS-anxiety and HADS-depression), respiratory function, patient satisfaction levels, and real-world inhaler therapy use. Results: Of the total 319 patients, 87% were male with a median age of 74 years. Most patients had mild or moderate COPD, according to Global Initiative for Chronic Obstructive Lung Disease stage. The total ASK-20 scores correlated significantly with the CAT, HADS-anxiety, and HADS-depression scores (r = 0.27, 0.33, and 0.29, respectively, p < 0.01). Multivariable analysis showed that CAT and HADS-anxiety scores had an independent and significant impact on the ASK-20 scores [β, standardized regression coefficient: 0.18 (95% CI, 0.03-0.35; p = 0.02), and 0.29 (95% CI, 0.17-0.42; p < 0.01), respectively]; however, the ASK-20 scores were not correlated with age, sex, body mass index, cohabitation, modified Medical Research Council Dyspnea Scale score, pulmonary function, disease duration, number of COPD exacerbations per year, comorbidities, inhaler numbers, nor inhaler components. Conclusion: The ASK-20 scores in patients with COPD were significantly associated with CAT and HADS scores. In Japan, Respimat was prescribed to younger patients and patients with lower CAT scores. The ASK-20, a simple evaluation method, is useful for identifying clinical factors affecting adherence in patients with COPD.

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contrasting

confidence: 85%

mentioning

confidence: 92%

The Relationship Between the “Adherence Starts with Knowledge-20” Questionnaire and Clinical Factors in Patients with COPD: A Multi-Center, Cross-Sectional Study

Akimoto

Hirai

Matsunaga

et al. 2020

COPD

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“… 28 Nevertheless, adherence to treatments among patients with COPD is especially poor, with rates of non-adherence ranging between 50% and 80%. 29 , 30 Non-adherence to treatment is associated with high mortality and morbidity, number of hospitalizations, and reduced quality of life. 31 Patients with good adherence to inhalers showed 1.9 times higher likelihood of achieving low clinical impact and stability than those with poor adherence rates.…”

Section: Discussionmentioning

confidence: 99%

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Soler-Cataluña¹,

Almagro²,

Huerta³

et al. 2021

COPD

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Background: Clinical control in chronic obstructive pulmonary disease (COPD) has not been completely characterized. A proposal of clinical control criteria (CCC) has been recently defined and validated as a tool for determining control, but there is scarce information on patients with severe COPD. Objective: To evaluate clinical control in severe COPD using the CCC. Patients and Methods: The study design was observational, multicenter, cross-sectional study involving 4801 patients with severe COPD in Spain. Clinical control was defined according to clinical impact (dyspnea grade, use of rescue treatment in last week, sputum color, and daily physical activity) and stability (exacerbations in last 3 months and patient's perception about health status). Clinical control of COPD was alternatively evaluated with the COPD assessment test (CAT) and the presence of exacerbations in the last 3 months. Results: According to CCC, 61.0% of patients had low clinical impact, and 41.4% showed clinical stability. Overall, 29.9% of patients had both low clinical impact and stability (controlled), whereas 70.1% showed high clinical impact and/or no clinical stability (non-controlled). COPD control was also assessed by using only the definition of CAT≤16 and no exacerbations in the last 3 months. Results obtained with this definition were similar to those obtained by CCC, and the concordance between both definitions was high (Kappa index = 0.698). Conclusion: By using the CCC, approximately only one third of patients with severe COPD were considered as controlled. Physical activity, adherence to inhalers, age, postbronchodilator FEV 1 , age-adjusted Charlson comorbidity index, and healthcare level were independent factors associated with COPD control.

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“…12 Adherence in patients with COPD is particularly poor, with non-adherence rates ranging from 50% to 80%. [13][14][15] Poor adherence is due to many reasons, such as socioeconomic factors, therapy-related factors and patientrelated factors. 16 Specifically, in COPD, there are factors directly related to inhaled therapy such as the complexity of treatment, problems with the use of the device and patients' preferences.…”

Section: Introductionmentioning

confidence: 99%

Estimation of the Clinical and Economic Impact of an Improvement in Adherence Based on the Use of Once-Daily Single-Inhaler Triple Therapy in Patients with COPD

Miravitlles¹,

Marín²,

Huerta³

et al. 2020

COPD

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Background: Adherence to treatment is key to achieve desired outcomes. In COPD, adherence is generally suboptimal and is impaired by treatment complexity. Objective: To estimate the clinical and economic impact of an improvement in treatment adherence due to an increased use of once-daily single-inhaler triple therapy (SITT) in patients with COPD. Patients and Methods: A 7-state Markov model with monthly cycles was developed. Patients with moderate-to-very severe COPD, for whom triple therapy is indicated, were included. Outcomes and costs were estimated and compared for two scenarios: current distribution of adherent patients treated with multiple inhaler triple therapies (MITT) vs a potential scenario where patients shifted to once-daily SITT. In the potential scenario, adherence improvement due to once-daily SITT attributes was estimated. Costing was based on the Spanish National Health System (NHS) perspective (€2019). A 3-year time horizon was defined considering a 3% discount rate for both costs and outcomes. Results: A target population of 185,111 patients with moderate-to-very severe COPD currently treated with MITT was estimated. A 20% increase in the use of once-daily SITT in the potential scenario raised adherence up to 52%. This resulted in 6835 exacerbations and 532 deaths avoided, with 775 LYs and 594 QALYs gained. Total savings reached €7,082,105. Exacerbation reduction accounted for 61.8% (€4,378,201) of savings. Conclusion: Increasing the use of once-daily SITT in patients with moderate-to-very severe COPD treated with triple therapy would be associated with an improvement in adherence, a reduction of exacerbations and deaths, and cost savings for the Spanish NHS.

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Adherence to inhaled therapy and its impact on chronic obstructive pulmonary disease (COPD)

Cited by 69 publications

References 37 publications

<p>The Relationship Between the “Adherence Starts with Knowledge-20” Questionnaire and Clinical Factors in Patients with COPD: A Multi-Center, Cross-Sectional Study</p>

<p>The Relationship Between the “Adherence Starts with Knowledge-20” Questionnaire and Clinical Factors in Patients with COPD: A Multi-Center, Cross-Sectional Study</p>

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

<p>Estimation of the Clinical and Economic Impact of an Improvement in Adherence Based on the Use of Once-Daily Single-Inhaler Triple Therapy in Patients with COPD</p>

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