Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment

Abstract

COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient’s characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.

Plain Language Summary

Treatment adherence in COPD is crucial as in many other chronic diseases, with specific issues due to inhaled route, and many factors involved. Low adherence in COPD has been linked to an increased risk of exacerbations and future mortality. Many interventions have been developed to improve treatment adherence in COPD. This review summarizes the current knowledge and future prospects for this important aspect of COPD treatment.

Keywords:

• COPD
• inhaled therapies
• adherence
• persistence
• posology

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr. Turégano-Yedro reports personal fees from GSK, Almirall, Astellas, Astra Zeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Esteve, FAES, Ferrer, Janssen, Lilly, MSD, Novartis, Novo Nordisk, Sanofi and Viatris. Dra. Trillo-Calvo reports personal fees from GSK, Boehringer Ingelheim, Menarini, AstraZeneca, Esteve, Lundbeck, Servier, Viatris and FAES. Dr. Maya-Viejo reports personal fees from GSK, MSD, Chiesi, AstraZeneca and Amgen. Dr. Navarro reports personal fees from GSK, personal fees from Chiesi, AstraZeneca, Novartis, Boehringer Ingelheim, Pfizer, Viatris, MSD, Ferrer, Novex, Organon, Lilly outside the submitted work. Dra. González reports personal fees from GSK, from Boehringer Ingelheim, personal fees and non-financial support from AstraZeneca, personal fees from Chiesi, Laboratorios BIAL and Laboratorios FAES outside the submitted work. Dr. Echave reports personal fees from GSK and non-financial support from Boehringer Ingelheim, outside the submitted work. Dra Doña has received honoraria during the last 3 years for lecturing, scientific advice, participation in clinical studies or writing for publications for (alphabetical order): Aflofarm, AstraZeneca, Bial, Boehringer, Chiesi, Faes, GSK, Novartis, Zambon. Dr. Alcázar-Navarrete reports grants and personal fees from GSK, personal fees and/or non-financial support from Boehringer Ingelheim, Chiesi, Laboratorios Menarini, AstraZeneca, Gilead, MSD, Laboratorios BIAL, Sanofi, Zambon, outside the submitted work.

Additional information

Funding

This article was funded by GSK. GSK was not involved in the design and development of this manuscript.