A systematic review

Background: Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. It was synthesized the global literature reporting the main determinants for adherence on these patients. Methods: Searches were made in Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical observational epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Randomeffects meta-analysis were used to summarize the numerical effect estimates. Findings: 47 studies were included, giving a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: higher age [RR=1.07 (1.03-1.10); I2=94; p<0.0001] good disease knowledge/literacy [RR=1.37 (1.28-1.47); I2=14; p=0.33]; obesity [RR=1.30 (1.12-1.50); I2=0; p=0.37]; good cognitive performance [RR=1.28 (1.17-1.40); I2=0; p=0.62]; higher income [RR=1.63 (1.05- 2.56); I2=0;p=0.52]; being employed [RR=0.87 (0.83-0.90); I2=0; p=0.76] and using multiple drugs/inhalers [RR=0.81 (0.79-0.84); I2=0; p=0.80]. Overall, the strength of the underlying evidence was only low to moderate. Interpretation: Many determinants may be associated, either to better adherence, such as age, good disease knowledge/literacy, obesity, good cognitive performance and higher income; either to poor adherence, such as being employed or using multiple inhalers. Personalized interventions should be taken in clinical practice to address patient’s adherence according to such features.Introdução / Objetivos: A adesão à terapêutica inalatória tem sido relatada como um grande problema a nível mundial, sendo particularmente relevante no tratamento da Asma e da Doença Pulmonar Obstrutiva Crónica (DPOC), considerando as suas barreiras e características. Realizou-se uma revisão sistemática da literatura mundial sobre os principais determinantes da adesão nesses pacientes. Métodos: A pesquisa foi realizada nas plataformas de dados Cochrane Library, MEDLINE, EMBASE e ISI Web of Science. Foram incluídos estudos epidemiológicos observacionais (estudos de coorte, caso-controle e transversais) que relataram a associação entre qualquer tipo de determinante e a adesão à terapêutica inalatória na Asma ou DPOC. Foi ainda realizada meta-análise de efeitos aleatórios de forma a resumir as associações de risco. Resultados: Foram incluídos 47 estudos, dando um total de 54.765 participantes. Nas metaanálises, foram apurados como determinantes significativos da adesão à terapêutica inalatória: a idade avançada [RR = 1,07 (1,03-1,10); I2 = 94; p <0,0001]; conhecimento acerca da doença / literacia em saúde [RR = 1,37 (1,28-1,47); I2 = 14; p = 0,33]; obesidade [RR = 1,30 (1,12-1,50); I2 = 0; p = 0,37]; bom desempenho cognitivo [RR = 1,28 (1,17-1,40); I2 = 0; p = 0,62]; maior rendimento familiar [RR = 1,63 (1,05-2,56); I2 = 0; p = 0,52]; estar empregado [RR = 0,87 (0,83-0,90); I2 = 0; p = 0,76] e no uso de múltiplos fármacos / inaladores [RR = 0,81 (0,79-0,84); I2 = 0; p = 0,80]. Na restante avaliação, a força da evidência subjacente às associações de risco foi baixa a moderada. Conclusão: Verificou-se que muitos determinantes podem estar associados a uma boa adesão, como os fatores idade, bom conhecimento / literacia sobre a doença, obesidade, bom desempenho cognitivo e maior rendimento familiar; associados a uma fraca adesão, identificou-se os seguintes fatores: estar empregado ou usar múltiplos inaladores. Intervenções personalizadas devem ser efetivadas na prática clínica de forma a abordar a adesão do paciente de acordo com as características evidenciadas

Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literature

Background Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients. Methods Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates. Results 47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03–1.10); I2 = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28–1.47); I2 = 14; p = 0.33]; obesity [RR = 1.30 (1.12–1.50); I2 = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17–1.40); I2 = 0; p = 0.62]; higher income [RR = 1.63 (1.05–2.56); I2 = 0; p = 0.52]; being employed [RR = 0.87 (0.83–0.90); I2 = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79–0.84); I2 = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate. Conclusions Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.info:eu-repo/semantics/publishedVersio