Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers

Yu, Andrew P.; Guérin, Annie; Leon, Diego Ponce de; Ramakrishnan, Karthik; Wu, Eric Q.; Mocarski, Michelle; Blum, Steve; Setyawan, Juliana

doi:10.3111/13696998.2011.594123

Cited by 123 publications

(113 citation statements)

References 24 publications

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“…Historically, use of and adherence to COPD maintenance medications has been suboptimal, with many individuals with COPD not receiving any maintenance medications (14,15,17). Among individuals who use COPD medications, adherence is low, which poses difficulties in medication management (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In this study, we found that only 22% of the sample achieved adherence of at least 80%, regardless of depression status.…”

Section: Original Researchmentioning

confidence: 63%

“…Maintenance medications, including inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics, have been shown to reduce exacerbations and improve lung function and health-related quality of life among patients with moderate to severe disease (5)(6)(7). Nonetheless, use of and adherence to COPD maintenance medications remain low, ranging from 29 to 56%, and contribute to increased hospitalization, health care costs, and mortality (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

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confidence: 99%

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Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

et al. 2016

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Rationale: Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities. Although depression has been associated with reduced adherence to maintenance medications used in other conditions, such as diabetes, little research has assessed the role of depression in COPD medication use and adherence.Objectives: The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. Methods:We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 2006 and 2010. We included beneficiaries with 2 years of continuous Medicare Parts A, B, and D coverage and at least two prescription fills for COPD maintenance medications after COPD diagnosis. We searched for prescription fills for inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations.Measurements and Main Results: Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. The exposure measure was depression. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. Average monthly adherence to COPD maintenance medications was low, peaking at 57% in the month after first fill and decreasing to 35% within 6 months. In our adjusted regression model, depression was associated with decreased adherence to COPD maintenance medications (odds ratio, 0.93; 95% confidence interval, 0.89-0.98).Conclusions: New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first 6 months after COPD diagnosis, and monitor patients' adherence to prescribed COPD medications to ensure best clinical outcomes.

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Section: Original Researchmentioning

confidence: 63%

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confidence: 99%

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

et al. 2016

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“…Moreover, the use of multiple inhalers needed for different medications in combination therapy (when disease progressed) confused the patients and further reduced compliance. (12,27) Patient-related issues, which impact adherence to medication, include inhaler preference or satisfaction level, co-morbidities and physical issues, cognitive and mood disorders, (26,(28)(29)(30) whereas physician-related issues include lack of awareness and knowledge on how to effectively instruct patients in proper inhaler use. (31,32) Often, HCPs prescribe inhalers based on available/preferred drugs, without considering whether the patient can effectively use the device, (33) potentially impacting adherence to the prescribed therapy.…”

Section: Discussionmentioning

confidence: 99%

Inhaler Devices for Chronic Obstructive Pulmonary Disease: Insights from Patients and Healthcare Practitioners

Molimard

Colthorpe

2015

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Background: The choice of inhaler device for patients with chronic obstructive pulmonary disease (COPD) depends upon multiple attributes. An online survey was devised to assess COPD patients' and healthcare practitioners' (HCPs; physicians and nurses) opinions and preferences for inhaler devices. Methods: Patients diagnosed with COPD ‡ 6 months from United States (US), United Kingdom (UK), France, and Germany, and HCPs from the US, UK, France, Italy, and Japan were enrolled to participate in an online quantitative 35 minutes survey. A proprietary analytical tool from Sawtooth Software was used to collect, randomize, and analyze participant opinions and preferences of device attributes, including functionality. Results: A total of 245 patients (mean age, 60.7 years) completed the survey. Of these, 124 and 121 patients were taking fluticasone/salmeterol, and tiotropium, respectively. Patients cited ease of use, dose recording, and dose capacity (single or multi-dose) as important attributes for the device. Key factors that patients considered would make the device easier to use were fewer steps to operate the inhaler, confirmation that the dose has been taken correctly, easier coordination of breathing manoeuver, and least resistance while inhaling. A total of 504 HCPs (380 physicians and 124 nurses) completed the survey, and cited patient satisfaction and ease of use as the most important attributes when selecting an inhaler device for patients. Dose recording and multi-dose versus singledose designs were given less importance than other attributes such as patient satisfaction and cost by HCPs. Conclusion:The survey provides important insights into what patients and HCPs consider to be key attributes of an ideal inhaler device for COPD management. Given that patients with COPD self-administer their COPD chronic medication and need to deliver the correct dose, it is important to consider these insights for the appropriate management of COPD.

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“…When a single inhaler device is replaced by multiple inhaler devices in asthma and COPD, a reduced adherence is observed [21,28,29]. A retrospective examination of the medical records of more than 11,000 patients was conducted to determine the clinical implications of switching from fixed-dose combinations to mono-component inhalers (a cost-saving decision by the Icelandic government).…”

Section: Implications Of Switching Devicesmentioning

confidence: 99%

The Importance of Continuity in Inhaler Device Choice for Asthma and Chronic Obstructive Pulmonary Disease

Bjermer

2014

Respiration

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Inhaled therapies are central to the treatment of asthma and chronic obstructive pulmonary disease. Physicians consider many factors when selecting the most appropriate inhaler device, including device efficacy and the cost to the health care system. This review aims to discuss the factors that are important when considering inhaler devices and the importance of continuity in the choice of inhaler device.A large number of factors can contribute to therapeutic outcomes with inhalation devices. The inhalation technique is critical to treatment success and differs substantially between inhaler devices. Misuse of an inhaler is common, and thorough training of patients and physicians is important to ensure correct utilization. Patient satisfaction is an important consideration because it is significantly correlated with compliance and better outcomes. Financial pressures contribute to decision making: although selecting the less expensive inhaler device might reduce direct treatment costs, it can have a large impact on disease control and the patient's well-being. Switching may be associated with a poor inhalation technique, reduced disease control and quality of life, increased use of other treatments and health care resources, and a greater chance of unsuccessful treatment. Nonconsensual switches can result in patient discontent, reduced confidence in the medication, and uncertainty regarding the degree of disease control. It is recommended that patients with stable disease remain on their current device. If a switch is considered, the patient should be consulted and the physician should take into account the patient's preference, their ability to correctly use the device, and the availability of the preferred drug in the preferred device.

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Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers

Abstract: Multiple long-acting inhaler users demonstrated lower treatment persistence and adherence rates than single long-acting inhaler users. Limitations of the study are related to the retrospective, observational design and use of claims data.

Cited by 123 publications

References 24 publications

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

Inhaler Devices for Chronic Obstructive Pulmonary Disease: Insights from Patients and Healthcare Practitioners

The Importance of Continuity in Inhaler Device Choice for Asthma and Chronic Obstructive Pulmonary Disease

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