Abstract
Background
Therapy adherence in COPD is crucial for treating symptoms, preventing exacerbations, and related complications. To achieve optimal adherence, it is important to recognize and understand a nonadherent patient.
Objective
To study perceptions and beliefs regarding COPD and inhaled medication in COPD patients with poor adherence.
Methods
Twenty patients (10 underuse, 10 overuse) were interviewed in semistructured in-depth interviews, about mental and physical health, illness perceptions, knowledge regarding COPD, and experience with, knowledge of, and acceptance of COPD medication and inhalation devices.
Results
A majority of patients did not fully accept their disease, showed little disease knowledge, and many revealed signs of depressive mood and severe fatigue. Overusers reported more grief about decreased participation in daily life and were more frustrated in general. Underusers claimed using less medication because they felt well, did not want to use too much medication, and used their inhalation devices too long. Overusers reported medication “dependency”; they tended to catastrophize when being without medication and discarded inhalation devices too early because they feared running out of medication.
Conclusion
Overusers and underusers showed a different pattern in perceptions and beliefs regarding inhaled medication and COPD.
Practical implications
It is important to understand the reasons for under- and overuse. Is it related to practical issues regarding knowledge or is it influenced by beliefs and/or anxiety concerning COPD or medication? These issues need to be addressed for improving adherence.
Acknowledgments
We wish to thank the patients who took part in this study. We also want to thank Jeroen Hilgerink and Maurizio Dessenes for their contribution in conducting and transcribing the interviews. The results of the current study were partly presented as a poster at the European Respiratory Society Annual Congress 2017, 9–13 September 2017. The poster’s abstract was published in European Respiratory Journal 2017;50:PA3944; DOI: 10.1183/1393003.congress-2017. PA3944.
Disclosure
The authors confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story. The authors report no conflicts of interest in this work.