COPD remains a leading cause of healthcare use despite the availability of effective inhaled therapies. We examined adherence to maintenance therapy by assessing the key components of good inhaler use: habit of use and inhaler technique. The relationship between adherence patterns, specific patient characteristics and clinical outcomes at one year was examined. We recruited 226 hospitalised patients with a diagnosis of COPD to this prospective observational study. Inhaler adherence was remotely monitored for 90 days after hospital discharge using an INCATM audio recording device. Cluster analysis grouped patients by their adherence behaviour based on the mean rate of attempted use and critical technique errors. The clinical and psychosocial characteristics of each cluster were examined. The rate of all–cause mortality and healthcare use at 12 months was recorded. Survival analysis was used to evaluate the time to first event across adherence groups. Adherence data was available for 195 patients. We identified four patterns of Adherence behaviour: (1) Regular habit of use and good technique (28%); (2) Regular habit of use and poor technique (21%); (3) Poor habit of use and good technique (33%); (4) Poor habit of use and poor technique (19%). The overall event rate was lowest in Cluster 1, 5.46/person/year. Cluster 2 had the lowest annual rate of hospital presentation, but accounted for the majority of community prescriptions for antibiotics and steroids, mean 4.6/person/ Poster sessions A228 Thorax 2017;72(Suppl 3):A1–278 on 20 June 2018 by guest. Protected by copyright. http://thorax.bmj.com/ Thorax: first published as 10.1136/thoraxjnl-2017-210983.410 on 15 November 2017. Downloaded from year. In an adjusted Cox regression model, Cluster 3 had an increased risk of any adverse outcome compared to Cluster 1, Hazard Ratio 1.8 (1.1–2.9), p=0.02. This group were notable for high anxiety scores and mild cognitive impairment. There was a stepwise increase in mortality across groups, from 11% in Cluster 1% to 33% in Cluster 4, p<0.001. Cluster 4 was older, female, with higher co-morbidity and cognitive impairment. We have identified four clusters of adherence behaviour. There is an association between adherence patterns and clinical outcomes. Each cluster also exhibits distinct clinical and psychosocial traits which may act as drivers of their behaviour. Personalised interventions targeting these specific adherence behaviour patterns may prove a cost-effective strategy to curtail COPD-related healthcare costs
