It's Bad-Really Bad-But Does it Matter? Medication Adherence in Chronic Obstructive Pulmonary Disease

A survey and analysis of inhalation medication adherence among 977 COPD patients in a region of northern China

OBJECTIVE

Inhalation therapy is recommended by the World Health Organization as the first-line treatment for chronic obstructive pulmonary disease (COPD) due to its rapid onset of action, good safety profile, ease of use, and portability. High medication adherence in COPD patients is crucial for enhancing disease management. The aim of this study was to assess the level of disease control, adherence to inhaled medication therapy, and potential factors influencing treatment adherence among COPD patients.

METHODS

A paper-based questionnaire was used to survey COPD patients who were outpatients or inpatients at the First Affiliated Hospital of Harbin Medical University between January 2019 and October 2023. Patients were included if they had been diagnosed with stable COPD for more than 12 months, were prescribed inhaled medications for post-consultation or post-discharge management, and had used these medications for at least 8 weeks with follow-up review. Questionnaires were administered at the time of consultation and at the 8-week follow-up to comprehensively evaluate patients' adherence to inhaled medications based on their medication administration methods, frequency, and other relevant factors. Categorical data were described using frequencies and percentages, and comparisons between groups were conducted using the chi-square test. For the analysis of risk factors, binary logistic regression analysis was employed. To avoid collinearity among variables, a stepwise regression method was utilized for variable selection. A P-value < 0.05 was considered statistically significant.

RESULTS

A total of 977 patients were included, with an average age of 63 ± 9 years. Among them, 40.9% of the patients demonstrated high adherence to inhaled medication therapy. Patients who were under 70 years old (P = 0.03), had a higher annual household income (P = 0.04), had family supervision (P = 0.01), and had medical insurance (P = 0.02) exhibited higher adherence to inhaled medication therapy.

CONCLUSION

Among the surveyed patients, those who were under 70 years old (OR = 5.1, CI = 1.13-23.11) and had family supervision (OR = 3.26, CI = 1.3-8.21) demonstrated better medication adherence. This suggests that physicians could potentially improve patient medication adherence, optimize disease control, and enhance the overall quality of life for these patients by considering targeted interventions, such as identifying and educating elderly patients, intensifying tailored promotional activities, and encouraging family members to supervise medication use.

Cost-related medication nonadherence in adults with COPD in the United States 2013-2020

BACKGROUND

Cost-related medication nonadherence (CRN) is associated with poor prognosis among patients with chronic obstructive pulmonary disease (COPD), a population that requires long-term treatment for secondary prevention. In this study, we aimed to estimate the prevalence and sociodemographic characteristics of CRN in individuals with COPD in the US.

METHODS

In a nationally representative survey of US adults in the National Health Interview Survey (2013-2020), we identified individuals aged ≥18 years with a self-reported history of COPD. Cross-sectional study.

RESULTS

Of the 15,928 surveyed individuals, a weighted 18.56% (2.39 million) reported experiencing CRN, including 12.50% (1.61 million) missing doses, 13.30% (1.72 million) taking lower than prescribed doses, and 15.74% (2.03 million) delaying filling prescriptions to save costs. Factors including age < 65 years, female sex, low family income, lack of health insurance, and multimorbidity were associated with CRN.

CONCLUSIONS

In the US, one in six adults with COPD reported CRN. The influencing factors of CRN are multifaceted and necessitating more rigorous research. Targeted interventions based on the identified influencing factors in this study are recommended to enhance medication adherence among COPD patients.

Identification of Symptom Clusters and Their Influencing Factors in Subgroups of Chinese Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

CONTEXT

Limited studies have identified symptom clusters (SCs) and their risk factors and the relationships with inflammatory biomarkers in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

OBJECTIVES

In this study, we aimed to investigate SCs in patients with AECOPD and explore their influencing factors and relationships with inflammatory biomarkers.

METHODS

Data were collected with sociodemographic and disease information questionnaires, and symptoms were measured with the revised Memorial Symptom Assessment Scale. SCs were extracted through exploratory factor analysis. Logistic regression analysis was conducted to explore the risk factors of SCs.

RESULTS

A total of 151 patients were recruited. Two SCs, namely, emotional and respiratory functional SCs, were identified. Logistic regression analysis showed that individuals with high C-reactive protein level, Charlson Comorbidity Index score, and high modified Medical Research Council Dyspnea Scale score were more likely to belong to the high-severity symptom subgroup than to the low-severity symptom group in the emotional SC. The patients with a low body mass index and without or lax inhaled drug therapy exhibited highly prominent predictors of membership in the high-severity symptom group of the respiratory functional SC.

CONCLUSION

Symptoms experienced by patients with AECOPD were grouped into specific clusters. Targeted interventions should be performed based on SCs, and influencing factors and biological mechanisms should be considered when providing individualized approaches and interventions.