Differences in Adherence and Non-Adherence Behaviour Patterns to Inhaler Devices Between COPD and Asthma Patients

Abstract

Differences between COPD and asthma may also differentially affect adherence to inhaled drugs in each disease. We aimed to determine differences in behaviour patterns of adherence and non-adherence to inhaled therapy between patients with COPD and patients with asthma using the Test of Adherence to Inhalers (TAI) questionnaire. A total of 910 patients (55% with asthma, 45% with COPD) participated in a cross-sectional multicentre study. Data recorded included sociodemographics, education level, asthma or COPD history, TAI score, the Asthma Control Test (ACT), the COPD Assessment Test (CAT) and spirometry. Asthma patients were statistically significant less adherents, 140 (28%) vs. 201 (49%), and the pattern of non-adherence was more frequently erratic (66.8% vs. 47.8%) and deliberate (47.2% vs. 34.1%) than COPD patients; however unwitting non-adherence was more frequently observed in COPD group (31.2% vs. 22.8%). Moreover, taking together all sample studied, only being younger than 50 years of age (OR 1.88 [95% CI: 1.26-2.81]) and active working status (OR 1.45 [95% CI: 1.00-2.09]) were risk factors for non-adherence in the multivariate analysis, while having asthma remained in the limits of the significance (OR 1.44 [95%CI: 0.97-2.14]). Even though non-adherence to inhalers is more frequently observed in asthma than in COPD patients and exhibited a different non-adherence patterns, these differences are more likely to be related to sociodemographic characteristics. However, differences in non-adherence patterns should be considered when designing specific education programmes tailored to each disease.

Asthma control and COPD symptom burden in patients using fixed-dose combination inhalers (SPRINT study)

“…23,24 Previous research has linked adherence with clinical symptoms and outcomes. 4,[25][26][27] However, even in adherent patients, other factors may influence outcomes. For example, inhaler technique is an important determinant of outcome, as it influences the dose of drug delivered to the lungs at each inhalation.…”

“…1 Inhaled medications are the mainstay of treatment for both COPD and asthma, 2,3 but many patients with asthma and COPD have poor treatment adherence and/or inhaler technique. 4,5 Improvements in these patient factors have the potential to substantially increase the effectiveness of therapy and help alleviate disease burden. [6][7][8][9] Combined inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) treatments play a central role in the management of persistent asthma (Step 3 and above) 2 and have been associated with beneficial effects on lung function, exacerbation rates, and patient-reported outcomes compared with each treatment alone in patients with COPD.…”

Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study

“…Very few studies have assessed adherence to treatment in COPD using patients’ self-report methods. One study has used two self-report questionnaires [ 24 ]; here, there was also a control group (electronic adherence) comprising smartphone user asthma patients using electronic inhaler devices (smart-inhalers). The TAI questionnaire showed a slightly better correlation with adherence determined using Smartinhaler ® electronic devices compared with the Morisky-Green test (10-item TAI score: ρ = 0.29; Morisky-Green score: ρ = 0.25) [ 24 ].…”

“…One study has used two self-report questionnaires [ 24 ]; here, there was also a control group (electronic adherence) comprising smartphone user asthma patients using electronic inhaler devices (smart-inhalers). The TAI questionnaire showed a slightly better correlation with adherence determined using Smartinhaler ® electronic devices compared with the Morisky-Green test (10-item TAI score: ρ = 0.29; Morisky-Green score: ρ = 0.25) [ 24 ]. Regarding the ability to identify adherent and non-adherent patients, the TAI questionnaire showed an intermediate position between the rates observed with the electronic devices and the Morisky-Green test [ 24 ].…”

Dispositivos de inhalación para asma y EPOC: una revisión de la literatura

“…On the other hand, physicians seem to have no particular preference for a specific device, and place more importance on ease of use when selecting inhalers for the elderly, or people with more severe stages of the most effective (28-30). It is essential to individualize each patient and focus on particular reasons for potential non-adherence (30). In a study performed in Spain, specialists recognize selection of inhalation devices as a strategic therapeutic decision, which should be based on the characteristics of each patient, since some devices may be more suitable according to each patient's profile (31).…”