COPD: adherence to therapy

Abstract

Adherence to medical therapies is a growing issue, so much so that the World Health Organization defined it as “a new pharmacological problem”. The main factors affecting compliance are: frequency of administration, rapid onset of action, role of device. The most severe consequence of non-adherence is the increased risk of poor clinical outcome, associated with worsening of the quality of life and increase in health-care expenditure. It appears crucial to identify those COPD patients who are “poorly or not at all compliant with their treatment”. In order to evaluate adherence to the medical therapy, several methods were proposed, the most effective of which turned out to be self-reports, i.e. simple, brief questionnaires (e.g. Morisky test). To increase the likelihood of quickly identifying non-compliant patients, it may be useful to administer a simple questionnaire to naïve subjects (for example, in the waiting room before an examination) including six specific items allowing to identify the patient’s key characteristics. Depending on the answers, patients who do not comply with their pharmacological treatment may be classified as belonging to 6 phenotypes. For patients who are already under treatment it might be useful to administer another short questionnaire during follow up examination. Once the risk of non-compliance is identified, four possible types of measures can be taken: prescription-related, educational, behavioral and complex combined measures (combination of two or more actions).Therefore, while it is clear that adherence in COPD is a critical issue, it is also obvious that raising awareness on the disease and improving cooperation among specialists, general practitioners, health-care professionals, and patients is the starting point at which this evolution should immediately begin. Each medication is able to foster good compliance with the therapy, and consequently to maximize the efficacy, by virtue of its specific inhaler and its own active ingredient.Electronic supplementary materialThe online version of this article (doi:10.1186/2049-6958-9-60) contains supplementary material, which is available to authorized users.

Suboptimal inhaler medication adherence and incorrect technique are common among chronic obstructive pulmonary disease patients

“…7,11,12 Other factors that are also thought to play a role in medication adherence include frequency of administration, rapid onset of action and ease of use of inhaler device. 21 We found that patients who reported high adherence were significantly older than the cohort who reported suboptimal adherence (73 vs. 68, p ¼ 0.001), which is consistent with the findings of previous studies. 6,7,22 It has been hypothesized that this may be due to more organized behaviour in old age, which can facilitate better adherence to medications.…”

Patients’ perspectives and preferences in the choice of inhalers: the case for Respimat^®or HandiHaler^®

“…Responses are scored using the Morisky scale to give a general indicator of risk 11. See Sanduzzi et al11 for the complete questionnaires.aQuestion relates to the patient’s health condition, and economic and family situations. Data from Sanduzzi et al11…”

“…Incorrect use of inhaler devices is common – real-world studies estimate that up to 94% of patients do not use their inhalers properly 6,8,9. This can lead to inadequate drug dosing, which, in turn, contributes to a worsening of quality of life and suboptimal disease control 8–11…”

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

“…This was also observed by Izquierdo et al28 in another population-based study in Spain in which they observed a high rate of compliance with treatment with LAMAs and no differences between the different products. In any case, patients initiating treatment with ACL or TIO in our study differed in variables that have been shown to have an impact on treatment adherence, for example, severity of the disease, age, and number of concomitant medications 20,21,29. Consequently, these important differences did not allow us to formally compare the rates of persistence between both drugs.…”