Adherence to controller therapy for chronic obstructive pulmonary disease: a review

Abstract

Objective:

While several studies have examined adherence to controller medications for the treatment of COPD, few systematic reviews have taken the translational step to identifying important and necessary areas for further research. The objective of this study was to review data on the outcomes of adherence to various controller therapies in patients with COPD in an effort to help prescribers understand adherence properties for each therapy.

Research design and methods:

This is a systematic review of studies investigating adherence to an array of controller pharmaceutical regimens. The studies were obtained from PubMed during 2008 and 2009 using the following key words: chronic obstructive pulmonary disease, COPD, adherence, controller medication, and persistence. Only articles encompassing adherence or persistence data to controller medications and published after 1990 were utilized.

Results:

After the search results were filtered for only the articles that pertained to adherence or persistence measurements in COPD, 35 articles remained; and finally, discounting those articles not published in English, articles which did not compare treatments for COPD, as well as those which were review articles, ten applicable articles remained. Each of these found low levels of medication adherence and/or persistence among patients receiving medications for COPD. Patients receiving fluticasone/salmeterol (FSC) and tiotropium (TIO) for treatment showed the highest adherence among all controller medications. Patients who were married, older, and white were more likely to adhere to their medications.

Conclusion:

Characteristics of the medication used (i.e. dosing schedule, formulation, etc.) as well as patient characteristics affect the adherence/persistence to medications for the treatment of COPD. Further patient education is necessary in order to effectively improve disease management and patient outcomes in COPD. There is a need for future research and educational efforts to improve adherence in COPD and more clearly identify specific behavioral and treatment characteristics associated with specific COPD medications that can facilitate adherence.

Key words:

• Controller therapy
• COPD
• Medication adherence
• Review

Transparency

Declaration of funding

Funding for this study was provided by GlaxoSmithKline.

Declaration of financial/other relationships

M.C., H.S. and C.B. have disclosed that they have received research support from and served as consultants to: GlaxoSmithKline, AstraZeneca LP, Sepracor, Viostat, Wyeth, Schering-Plough, Premier, and NovoNordisk. D.L. has disclosed that she has received research support from GlaxoSmithKline and Novartis. D.M. has disclosed that he has received research support and served as a consultant to: GlaxoSmithKline, Pfizer Pharmaceuticals, Boehringer-Ingelheim, and AstraZeneca. A.A.D. is an employee of GlaxoSmithKline.

Peer reviewers may receive honoraria from CMRO for their review work. The peer reviewers have disclosed no relevant financial relationships.

Acknowledgements

The authors would like to thank Lauren Farmer, BS and Marshal Carter, BS of Lovelace Respiratory Research Institute for research assistance, Susan Berry, MSW of Lovelace Respiratory Research Institute for research and editorial assistance, and Mimi Kim, PhD of Lovelace Respiratory Research Institute for editorial assistance.