COPD: understanding patients’ adherence to inhaled medications

Figures & data

Table 1 Demographic, clinical and functional characteristics of COPD patients

Characteristics	n=319
Mean ± SD age (years)	67.7±10.26
Age ≥65 years	198 (62.1)
Male gender	249 (78.1)
Education level <4 school years	93 (29.2)
Education level ≤6 school years	281 (88.1)
Very low monthly income (<530 euros)	207 (65.5)
Low monthly income (<1,060 euros)	295 (93.3)
Graffar social classification 3 and 4	112 (35.5); 184 (58.4)
mMRC grade ≥2	196 (62.6)
CAT score ≥10	158 (72.4)
Frequent ECOPD (≥2/last year)	121 (37.9)
Mean FEV1 L (%)	1.38 (53.9)
GOLD 2017 stage and classification
I – 34 (10.7); II – 136 (42.6); III – 109 (34.2); IV – 40 (12.5)
A – 73 (22.9); B – 127 (39.8); C – 7 (2.2); D – 112 (35.1)

Note: Data shown as mean ± SD or n (%).

Abbreviations: ECOPD, COPD exacerbation; CAT, COPD assessment test; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 2 Relationship between BMQ and adherence to inhaled medication

	BMQ necessity (mean ± SD)	BMQ concern (mean ± SD)
Adherent patients	Score=20.58±4.104	Score=10.76±4.265
Non-adherent patients	Score=15.75±5.777	Score=10.65±4.383
P-value	P=0.000	P=0.877

Abbreviation: BMQ, Beliefs about Medications Questionnaire.

Table 3 Relationship between non-adherence and GOLD 2017 stage and classification

	GOLD I–IV				Total
	I	II	III	IV
Non-adherent
N	9	28	12	1	50
%	18.0	56.0	24.0	2.0	100.0
Adherent
N	19	97	96	38	250
%	7.6	38.8	38.4	15.2	100.0
Total
N	28	125	108	39	300
%	9.3	41.7	36.0	13.0	100.0
X^2=15.772; P-value=0.001
	A–D 17				Total
	A	B	C	D
Non-adherent
N	16	19	2	13	50
%	32.0	38.0	4.0	26.0	100.0
Adherent
N	45	103	5	97	250
%	18.0	41.2	2.0	38.8	100.0
Total
N	61	122	7	110	300
%	20.3	40.7	2.3	36.7	100.0
X^2=6.697; P -value=0.082

Abbreviation: GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table

Reasons

– Use as needed

– Shift in daily routine

– Fear of side effects

– Concerned about long-term toxicity or tolerance

– Confusion

– Dependence on others

– Economic

Patterns

– Forgetfulness

– Carelessness with schedules

– Ran out of medication

– Anticipation of inhalation

– Increased frequency/number of inhalations

– Stop all medication when less symptomatic

– Reduction in the number of inhalations/suppression of doses

– Suppression of one of the inhalers

– Complete withdrawal

Table

Health-related behaviors

– Having a caregiver (or some kind of help to remember, prepare

and purchase the medication)

– Having a daily routine (that hinders oblivion)

– Use of quick-relief medication (avoiding excessive use of regular medications)

– Having spare medication/easy access to medications: discipline

(on taking the medication)

Health-related experiences

– Previous negative experiences (previous dropout-related exacerbations)

– Satisfaction with prescribed medication (feeling better)

Health-related beliefs

– Trust in the doctor (and their knowledge)

– Trust in the medication (and its effectiveness)