COPD: understanding patients’ adherence to inhaled medications
Received 28 December 2017
Accepted for publication 18 March 2018
Published 6 September 2018 Volume 2018:13 Pages 2767—2773
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
António Duarte-de-Araújo,1–3 Pedro Teixeira,1,2 Venceslau Hespanhol,4,5 Jaime Correia-de-Sousa1,2,6
1Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; 2ICVS/3B’s, PT Government Associate Laboratory, Braga, Portugal; 3Respiratory Department, H. Sª Oliveira, Guimarães, Portugal; 4Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal; 5Faculty of Medicine (FMUP), University of Porto, Porto, Portugal; 6Horizonte Family Health Unit, Matosinhos, Portugal
Background and objective: Adherence to inhaled medications by COPD patients is a challenging issue, but relatively understudied. The aim of this study is the characterization of adherence to inhaled medications by COPD patients, with a focus on patient-related determinants.
Methods: Stable COPD outpatients ≥40 years of age from a respiratory unit and diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease criteria were included in a cross-sectional study. The Measure of Treatment Adherence (MTA), the Beliefs about Medications Questionnaire (BMQ) and demographic, clinical, and COPD questionnaires were used. After completing these questionnaires, semi-structured interviews were carried out and participants were encouraged to justify their opinions and behaviors. Field notes were made during the interviews and each interview was analyzed before the next one. Quantitative and qualitative analyses of the variables were then performed.
Results: A total of 300 out of 319 participants (mean age =67.7 years, 78.1% males) completed the MTA questionnaire. Of these, 31.3% were considered poorly adherent and 16.7% as non-adherent to the inhaled therapy. A statistically significant negative association was found between adherence and current smoking status (P=0.044), and between adherence and FEV1% (P=0.000). The mean BMQ Necessity score was higher in adherent patients (P=0.000), but the the mean Concern score was similar for both (P=0.877). We found nine patterns of poor-adherence, six reasons given for poor-adherence behaviors, five reasons for good-adherence behaviors and three patient-related domains on adherence to medications.
Conclusion: Adherence is related to need perception and to the functional severity of the disease. A non-adherent patient is usually a current smoker with lower degree of airflow limitation and lower perception of medication necessity. New information obtained was related to the patterns and reasons for different adherence behaviors, which are based on three major groups of patient related-determinants: health-related experiences, health-related behaviors and health-related beliefs.
Keywords: COPD, adherence, inhaled medications, adherence behaviors, beliefs
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