Differences in adherence to common inhaled medications in COPD

Objective: To study differences in adherence to common inhaled medications in COPD. Methods: Adherence of 795 patients was recorded from pharmacy records over 3 years in the COMIC cohort. It was expressed as percentage and deemed good at ≥75–≤125%, sub-optimal ≥50–<75%, and poor <50% (underuse) or >125% (overuse). Most patients used more than one medication, so we present 1379 medication periods. Results: The percentages of patients with good therapy adherence ranged from 43.2 (beclomethasone) –75.8% (tiotropium); suboptimal from 2.3 (budesonide) –23.3% (fluticasone); underuse from 4.4 (formoterol/budesonide) –18.2% (beclomethasone); and overuse from 5.1 (salmeterol) –38.6% (budesonide). Patients using fluticasone or salmeterol/fluticasone have a 2.3 and 2.0-fold increased risk of suboptimal versus good adherence compared to tiotropium. Patients using salmeterol/fluticasone or beclomethasone have a 2.3- and 4.6-fold increased risk of underuse versus good adherence compared to tiotropium. Patients using budesonide, salmeterol/fluticasone, formoterol/budesonide, ciclesonide and beclomethasone have an increased risk of overuse versus good adherence compared to tiotropium. Adherence to inhalation medication is inversely related to lung function. Conclusion: Therapy adherence to inhalation medication for the treatment of COPD is in our study related to the medication prescribed. Tiotropium showed the highest percentage of patients with good adherence, followed by ciclesonide, both dosed once daily. The idea of improving adherence by using combined preparations cannot be confirmed in this study. Further research is needed to investigate the possibilities of improving adherence by changing inhalation medication

The influence of type of inhalation device on adherence of COPD patients to inhaled medication

Objective: To study the influence of type of inhalation device on medication adherence of COPD patients. Methods: Adherence to inhalation medication of 795 patients was recorded from pharmacy records over 3 years. It was expressed as percentage and deemed good at ≥75–≤125%, sub-optimal ≥50–<75%, and poor <50% (underuse) or >125% (overuse). Since most patients used more than one device, 1379 medication periods were analyzed. Results: Patients using a Metered Dose Inhaler (MDI) or Diskus had a 2.3-fold and 2.2-fold increased risk, respectively, of suboptimal adherence versus good adherence, compared to Handihaler and a 2.1-fold and 2.2-fold increased risk, respectively, of underuse versus good adherence compared to Handihaler. Turbuhaler, MDI, Respimat had a 7.9-fold, 3.5-fold, and 2.0-fold increased risk, of overuse versus good adherence compared to Handihaler. Conclusions: In COPD, adherence to inhalation medication is device-related. Overuse was most pronounced for devices without a dose counter, devices with the ability to load a dosage without actual inhalation, or devices lacking feedback of correct inhalation. The design of the device seems to be related to underuse and overuse of inhaled medication. Future research might investigate whether prescribing a different device with similar medication improves therapy adherence

Adherence to inhaled medication in COPD: predictors and outcomes

This thesis describes therapy adherence to inhaled medication in COPD based on data of the “Cohort of Mortality and Inflammation in COPD” (COMIC) study, a single centre prospective cohort study in the Medisch Spectrum Twente hospital, Enschede. From December 2005 till April 2010, 795 patients were included with a follow-up period of three years. In order to investigate therapy adherence four adherence categories were introduced, optimal (75-125%), suboptimal (50-125%). Therapy adherence in COPD was related to the type of inhaled medication and inhalation device and was inversely related to lung function. Higher lung function was a predictor for suboptimal adherence and underuse. A lower lung function, anxiety for dyspnea, and current smoking were predictors for overuse. Non-adherent inhaled corticosteroid (ICS) users had little knowledge of COPD and how to manage their COPD, including a lack of knowledge about the mechanisms of action of medication, and when which medication should be used. Underusers claimed using less medication because they felt well, did not want to use too much medication and used their inhalation devices too long after they were empty. Overusers reported medication “dependency” in the sense that they tended to catastrophize when being without medication and discarded inhalation devices too early because they feared to run out of medication. Non-adherence with tiotropium was associated with an increased risk of having a severe COPD exacerbation that needs a hospitalization (AECOPD) and time to first community acquired pneumonia (CAP) compared to optimal use. Suboptimal and underuse of ICS and tiotropium were associated with a substantially increased mortality risk compared to optimal use, with even higher risks in underusers than suboptimal users. It seems that inhalation therapy in COPD is too complex. Every patient should receive a tailored advice and interventions that are developed to improve adherence. Local pharmacists can play an important role in integrated COPD patient care

Optimal adherence with inhaled corticosteroids is related to better health status

Objective: To study the relationship between therapy adherence with inhaled corticosteroids and health status measured with the Clinical COPD Questionnaire (CCQ). Methods: Therapy adherence and health status (CCQ) of 583 patients was recorded from pharmacy records over 3 years. It was expressed as percentage and deemed good at 75-125%, suboptimal at 5075%, and poor at 125%. Results: Optimal adherence showed highest quality of life (lower scores) on questions 1 (short of breath at rest), 3 (concerned getting a cold, breathing getting worse), 8 (limited in moderate physical activities) 9 (limited in daily activity) There were no differences in domain and total scores (data not shown) between the adherence groups. Conclusion: Optimal adherence always scored highest on quality of life, although not significant on every question/domain. (Table Presented)