Adherence to Inhalation Devices in Patients with Chronic Obstructive Pulmonary Disease

Figures & data

Table 1 Comparison of the Type of Inhaler with Some Sociodemographic, Clinical and Pharmacological Variables, in Patients Diagnosed with Chronic Obstructive Pulmonary Disease, Colombia

Variables	Total		Metered Dose Inhalers^a		Metered Dose Inhalers^b		Multi-Dose Dry Powder Inhalers		Single-Dose Dry Powder Inhalers		Soft Mist Inhaler
	n=500	%	n=100	%	n=100	%	n=100	%	n=100	%	n=100	%
Sociodemographic	–	–	–	–	–	–	–	–	–	–	–	–
Woman	281	59.2	63	63.0	60	60.0	54	54.0	44	44.0	60	60.0
Age; median (IQR)^c	79.0 (70.0–86.0)		78.5 (70.0–86.8)		78.0 (69.0–85.0)		77.5 (70.0–84.0)		79.0 (71.0–85.0)		81.0 (70.3–88.0)
Primary education	242	48.4	51	51.0	44	44.0	55	55.0	50	50.0	42	42.0
Active occupation	217	43.4	41	41.0	38	38.0	50	50.0	42	42.0	46	46.0
Contributory regime	389	77.8	77	77.0	75	75.0	81	81.0	79	79.0	77	77.0
Clinic	–	–	–	–	–	–	–	–	–	–	–	–
Diagnostic time (years); median (IQR)	8.0 (4.0–11.0)		8.0 (4.0–12.8)		7.5 (3.0–10.8)		8.0 (4.0–11.0)		7.5 (4.0–11.0)		8.0 (3.0–13.0)
mMRC^d ≥2 points	381	76.2	78	78.0	77	77.0	78	78.0	74	74.0	74	74.0
Exacerbations in the past year	186	37.2	35	35.0	40	40.0	42	42.0	29	29.0	40	40.0
Hospitalizations in the last year	114	22.8	21	21.0	24	24.0	27	27.0	19	19.0	23	23.0
GOLD^e classification	–	–	–	–	–	–	–	–	–	–	–	–
A	94	18.8	17	17.0	20	20.0	13	13.0	20	20.0	24	24.0
B	225	45.0	49	49.0	48	48.0	44	44.0	46	46.0	38	38.0
E	181	39.2	34	34.0	32	32.0	43	43.0	34	34.0	38	38.0
Use of home oxygen	168	33.6	27	27.0	33	33.0	42	42.0	32	32.0	34	34.0
Comorbidities	–	–	–	–	–	–	–	–	–	–	–	–
Cardiovascular	376	75.2	83	83.0	74	74.0	74	74.0	72	72.0	73	73.0
Endocrine	181	36.2	37	37.0	41	41.0	35	35.0	28	28.0	40	40.0
Rheumatologic	88	17.6	12	12.0	20	20.0	23	23.0	15	15.0	18	18.0
Pharmacological	–	–	–	–	–	–	–	–	–	–	–	–
Type of training received	–	–	–	–	–	–	–	–	–	–	–	–
Demonstration	361	72.2	76	76.0	70	70.0	70	70.0	68	68.0	77	77.0
Verbal instructions for use	175	35.0	34	34.0	34	34.0	36	36.0	42	42.0	29	29.0
Information leaflet	25	5.0	7	7.0	6	6.0	5	5.0	0	0.0	7	7.0
Video	11	2.2	2	2.0	3	3.0	2	2.0	3	3.0	1	1.0
Professional who carried out the training	–	–	–	–	–	–	–	–	–	–	–	–
Medical specialist	281	56.2	58	58.0	52	52.0	49	49.0	56	56.0	66	66.0
General practitioner	172	34.4	37	37.0	42	42.0	38	38.0	33	33.0	22	22.0
Others	71	14.2	14	14.0	11	11.0	14	14.0	16	16.0	16	16.0
Usage time with the device (years); median (IQR)	2.0 (1.0–5.0)		2.0 (0.6–5.0)		3.0 (1.0–5.0)		2.0 (1.0–5.0)		2.0 (1.0–4.8)		2.0 (1.0–4.0)

Notes: ^aShort-acting bronchodilators; ^bLong-acting bronchodilators/corticosteroids. ^cIQR: Interquartile range; ^dmMRC: modified Medical Research Council; ^eGOLD: Global Initiative for Chronic Obstructive Lung Disease.

Table 2 Comparison of the Type of Inhaler with the Score Obtained in Each Question of TAI-10 Questionnaire (Test of the Adherence to Inhalers), in Patients with a Diagnosis of Chronic Obstructive Pulmonary Disease, Colombia

TAI-10^a Questionnaire Variables	Total (n=500)	Metered Dose Inhalers^b	Metered Dose Inhalers^c	Multi-Dose Dry Powder Inhalers	Single-Dose Dry Powder Inhalers	Soft Mist Inhaler
	Mean (SD)^d	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
During the last 7 days, how many times did you forget to take your usual inhalers?	4.7 ± 0.7	4.7 ± 0.7	4.8 ± 0.6	4.7 ± 0.8	4.8 ± 0.6	4.7 ± 0.8
Do you forget to take inhalers?	4.6 ± 0.7	4.6 ± 0.7	4.7 ± 0.6	4.6 ± 0.7	4.6 ± 0.7	4.6 ± 0.8
When you feel good about your illness, do you stop taking your inhalers?	4.5 ± 1.1	4.5 ± 1.1	4.5 ± 1.1	4.3 ± 1.2	4.4 ± 1.1	4.6 ± 1.1
When you are on vacation or weekend, do you stop taking your inhalers?	4.7 ± 0.7	4.8 ± 0.6	4.7 ± 0.7	4.7 ± 0.8	4.7 ± 0.7	4.7 ± 0.9
When you are nervous or sad, do you stop taking your inhalers?	4.8 ± 0.6	4.9 ± 0.5	4.8 ± 0.6	4.8 ± 0.6	4.8 ± 0.6	4.8 ± 0.7
Do you stop taking your inhalers because of fear of side effects?	4.8 ± 0.6	4.9 ± 0.6	4.9 ± 0.5	4.9 ± 0.5	4.8 ± 0.6	4.8 ± 0.8
Do you stop taking your inhalers because of considering they are useless to treat your condition?	4.9 ± 0.5	4.9 ± 0.5	4.9 ± 0.4	4.9 ± 0.4	4.8 ± 0.6	4.9 ± 0.6
Do you take fewer inhalations than those prescribed by your doctor?	4.7 ± 0.8	4.7 ± 0.8	4.8 ± 0.5	4.6 ± 0.9	4.7 ± 0.8	4.8 ± 0.8
Do you stop taking your inhalers because you believe they interfere with your everyday or working life?	4.9 ± 0.4	4.9 ± 0.4	4.9 ± 0.3	4.9 ± 0.4	4.9 ± 0.4	4.9 ± 0.7
Do you stop taking your inhalers because you have difficulties to pay them?	4.7 ± 0.6	4.8 ± 0.5	4.8 ± 0.5	4.8 ± 0.6	4.8 ± 0.5	4.7 ± 0.9
Total	47.4 ± 5.3	47.6 ± 4.8	47.7 ± 4.6	47.2 ± 4.8	47.3 ± 5.0	47.4 ± 6.8
Good adherence (50 points); (n /%)	283 (56.6)	58 (58.0)	60 (60.0)	54 (54.0)	48 (48.0)	63 (63.0)
Intermediate adherence (46–49 points); (n /%)	127 (25.4)	24 (24.0)	23 (23.0)	24 (24.0)	35 (35.0)	21 (21.0)
Poor adherence (≤45 points); (n /%)	90 (18.0)	18 (18.0)	17 (17.0)	22 (22.0)	17 (17.0)	16 (16.0)

Notes: ^aTAI: Test of the Adherence to Inhalers; ^bShort-acting bronchodilators; ^cLong-acting bronchodilators/corticosteroids; ^dSD: Standard deviation. Adapted from Plaza V, Fernández-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2016;29(2):142–152. Creative Commons.¹²

Table 3 Comparison of the Type of Inhaler with the Score Obtained in Each Question of FSI-10 Questionnaire (Feeling of Satisfaction with Inhaler), in Patients with a Diagnosis of Chronic Obstructive Pulmonary Disease, Colombia

FSI-10 Questionnaire Variables	Total (n=500)	Metered Dose Inhalers^a	Metered Dose Inhalers^b	Multi-Dose Dry Powder Inhalers	Single-Dose Dry Powder Inhalers	Soft Mist Inhaler
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
Was it easy for you to learn to operate this inhalation device?	4.7 ± 0.6	4.8 ± 0.5	4.8 ± 0.6	4.8 ± 0.6	4.7 ± 0.7	4.7 ± 0.8
Was it easy for you to prepare this inhalation device for inhalation?	4.8 ± 0.6	4.8 ± 0.5	4.8 ± 0.4	4.8 ± 0.5	4.7 ± 0.6	4.7 ± 0.8
Was this inhalation device easy for you to use?	4.7 ± 0.7	4.7 ± 0.7	4.8 ± 0.6	4.8 ± 0.5	4.7 ± 0.8	4.7 ± 0.9
Has it been easy for you to keep the inhalation device in good working order and hygiene?	4.8 ± 0.6	4.8 ± 0.4	4.8 ± 0.5	4.8 ± 0.5	4.8 ± 0.4	4.7 ± 0.8
Was it easy for you to continue your normal activities using this inhalation device?	4.8 ± 0.6	4.8 ± 0.5	4.8 ± 0.6	4.8 ± 0.4	4.8 ± 0.6	4.7 ± 0.8
Was it comfortable for you to adapt the inhalation device to your lips?	4.8 ± 0.6	4.8 ± 0.5	4.8 ± 0.5	4.8 ± 0.4	4.7 ± 0.8	4.7 ± 0.8
Was the inhalation device comfortable for you in terms of weight and size?	4.8 ± 0.5	4.8 ± 0.5	4.8 ± 0.5	4.8 ± 0.5	4.8 ± 0.5	4.8 ± 0.8
Was the inhalation device comfortable for you to carry (transport) with you?	4.8 ± 0.5	4.8 ± 0.5	4.9 ± 0.4	4.8 ± 0.5	4.9 ± 0.4	4.8 ± 0.8
When you inhale, are you left with the feeling that you have used the inhalation device correctly?	4.7 ± 0.7	4.7 ± 0.7	4.7 ± 0.6	4.8 ± 0.5	4.7 ± 0.7	4.7 ± 0.8
Overall, taking all of the above into account, are you satisfied with the inhalation device?	4.7 ± 0.6	4.8 ± 0.5	4.7 ± 0.6	4.8 ± 0.5	4.7 ± 0.7	4.7 ± 0.8
Total	47.6 ± 5.4	47.9 ± 4.5	47.8 ± 4.4	47.9 ± 4.3	47.5 ± 5.3	47.1 ± 7.7
High satisfaction ≥44 points (n /%)	421 (84.2)	85 (85.0)	86 (86)	83 (83)	82 (82)	85 (85)

Notes: ^aShort-acting bronchodilators; ^bLong-acting bronchodilators/corticosteroids.

Abbreviations: FSI, Feeling of Satisfaction with Inhaler; SD, Standard deviation.

Table 4 Binary Logistic Regression on the Variables Associated with Good Adherence to Inhalation Devices, in Patients with a Diagnosis of Chronic Obstructive Pulmonary Disease, Colombia

Variables	Sig.	OR	95% CI
			Lower	Upper
Women	0.065	1.446	0.978	2.140
Age (continuous)	0.835	1.002	0.983	1.022
Origin Central Region	0.005	0.556	0.368	0.839
High school or college	0.540	1.143	0.746	1.750
Active occupation	0.930	1.018	0.685	1.512
Cardiovascular comorbidities	0.761	0.930	0.585	1.481
Diabetes mellitus	0.043	0.608	0.376	0.984
COPD evolution time less than 5 years	0.010	0.570	0.372	0.873
Hospitalizations for COPD in the last year	0.605	0.878	0.536	1.438
Use of home oxygen	0.134	1.407	0.900	2.197
Training carried out by a specialist doctor	0.006	1.756	1.173	2.628
Use of the inhalation device less than one year	0.029	1.596	1.049	2.430
Use soft mist inhaler	0.149	1.439	0.878	2.359
Use of short-acting β2-agonists	0.026	1.587	1.056	2.385
Satisfaction FSI-10 questionnaire (continuous)	<0.001	1.094	1.048	1.142

Abbreviations: Sig, Statistical significance; OR, Odds Ratio; CI, Confidence interval; COPD, Chronic Obstructive Pulmonary Disease; FSI, Feeling of Satisfaction with Inhaler.

Plaza V, Fernández-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2016;29(2):142–152. doi:10.1089/jamp.2015.1212

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