Medication adherence issues in patients treated for COPD

Abstract

Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%–60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient’s selection of both the device and the regimen. Patient’s health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence.

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence

“…Existing evidence suggests that IT decline over time due to patients forgetting the proper instructions [17,18,29]. However, there was a disparity between the Japanese and the Australian study reviewed about the optimal frequency for IT rechecking and education.…”

“…Regarding IT, evidence from Europe shows that up to 50% of patients fail to use their inhalers correctly [17]. Whereas, another review highlighted that nearly 100% of patients perform mistakes in their IT that consequently result in delivering an inadequate dose of the inhaled medication [18]. Poor adherence and suboptimal IT can lead to increased healthcare costs and poor health outcomes.…”

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

“…10 In addition, we included variables possibly associated with adherence including comorbidity, age, gender, visits to the general practitioner, socioeconomic status, psychosocial variables, as well as the year of cohort entry. [18][19][20][21][22][23][24] Appendix- Table 2 (available online) shows a detailed description of all variables. Since previous adherence has been identified as a dominant predictor of future adherence in COPD, 25 we did a fifth sensitivity analysis that did not include previous adherence among possible explanatory variables in the models in order to investigate possible masking of other variables caused by collinearity.…”

Emergency Department Visits after Diagnosed Chronic Obstructive Pulmonary Disease in Aboriginal People in Alberta, Canada

“…It is possible that Aboriginal people with COPD use more ED services, either because they have higher disease severity 29 that leads to frequent or more severe exacerbations, or due to poorer chronic management for COPD and/or comorbidities that lead to treatment failure and disease relapse that requires frequent emergency care. 30 It is also possible that certain Aboriginal groups use the ED as a "safety net of health care" rather than primary care providers, particularly if they belong to socially and economically disadvantaged communities. 31,32 Data from the 2006 Aboriginal Peoples Survey (APS) showed that the proportion of Aboriginal people who have a regular physician (81%) is lower than the national average in Canada (85%).…”