Background: COPD affects millions of people worldwide. Poor treatment
adherence contributes to increased symptom severity, morbidity and
mortality. This study was designed to investigate adherence to COPD
treatment in Turkey and Saudi Arabia.
Methods: An observational, cross-sectional study in adult COPD patients
in Turkey and Saudi Arabia. Through physician-led interviews, data were
collected on sociodemographics and disease history, including the impact
of COPD on health status using the COPD Assessment Test (CAT); quality
of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and
anxiety and depression using the Hospital Anxiety and Depression Scale
(HADS). Treatment adherence was measured using the 8-item Morisky
Medication Adherence Scale (MMAS-8). Multivariate logistic regression
analysis examined the predictors of non-adherence and the impact of
adherence on symptom severity.
Results: Four hundred and five COPD patients participated: 199 in Turkey
and 206 in Saudi Arabia. Overall, 49.2\% reported low adherence (MMAS-8
15) compared
to 58.4\% reporting medium/high adherence (p = 0.0008). Patients with
low adherence reported a lower mean 3-level EQ-5D utility value (0.54
+/- 0.35) compared to those with medium/high adherence (0.64 +/- 0.30; p
10 was associated with
lower adherence (OR 2.50 {[}95\% CI: 1.43-4.39] and 2.43 {[}95\% CI:
1.39-4.25], respectively; p = 0.0008). Being a high school/college
graduate was associated with better adherence compared with no high
school (OR 0.57 {[}95\% CI: 0.33-0.98] and 0.38 {[}95\% CI: 0.15-1.00],
respectively; p = 0.0310). After adjusting for age, gender, and country,
a significant association between treatment adherence (MMAS-8 score >=
6) and lower disease impact (CAT <= 15) was observed (OR 0.56 {[}95\%
CI: 0.33-0.95]; p = 0.0314).
Conclusion: Adherence to COPD treatment is poor in Turkey and Saudi
Arabia. Non-adherence to treatment is associated with higher disease
impact and reduced quality of life. Depression, age, and level of
education were independent determinants of adherence