The Importance of Inhaler Adherence to Prevent COPD Exacerbations

It has been shown that the better outcomes of chronic obstructive pulmonary disease (COPD) are closely associated with adherence to drug therapy, independent of the treatment administered. The clinical trial Towards a Revolution in COPD Health (TORCH) study clearly showed in a three year follow up that patients with good adherence to their inhaler treatment presented a longer time before the first exacerbation, a lower susceptibility to exacerbation and lower all-cause mortality. The Latin American Study of 24-h Symptoms in Chronic Obstructive Pulmonary Disease (LASSYC), a real-life study, evaluated the self-reported inhaler adherence in COPD patients in seven countries in a cross-sectional non-interventional study and found that approximately 50% of the patients had good adherence, 30% moderate adherence and 20% poor adherence. Adherence to inhaler may be evaluated by the specific inhaler adherence questionnaire, the Test of Adherence to Inhalers (TAI). Several factors may predict the incorrect use of inhalers or adherence in COPD outpatient, including the number of devices and the daily dosing frequency. Ideally, patient education, simplicity of the device operation, the use of just one device for multiple medications and the best adaptation of the patient to the inhaler should guide the physician in prescribing the device.

[1]  W. Wright,et al.  Hair analysis to monitor adherence to prescribed chronic inhaler drug therapy in patients with asthma or COPD. , 2018, Pulmonary pharmacology & therapeutics.

[2]  A. Ismaila,et al.  Impact of adherence to treatment with fluticasone propionate/salmeterol in asthma patients , 2014, Current medical research and opinion.

[3]  A. L. Dal-Fabbro,et al.  Adherence to long term therapies: evidence for action , 2005 .

[4]  N PritchardJohn,et al.  Emerging Technologies for Electronic Monitoring of Adherence, Inhaler Competence, and True Adherence , 2015 .

[5]  S. Adlis,et al.  Comparison of patients' compliance with prescribed oral and inhaled asthma medications. , 1994, Archives of internal medicine.

[6]  V. Backer,et al.  Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. , 2013, Respiratory medicine.

[7]  J. L. Rau,et al.  Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. , 2005, Chest.

[8]  J A Anderson,et al.  Adherence to inhaled therapy, mortality and hospital admission in COPD , 2009, Thorax.

[9]  M. Dolovich,et al.  Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. , 2018, The journal of allergy and clinical immunology. In practice.

[10]  J. Wedzicha,et al.  Indacaterol-Glycopyrronium versus Salmeterol-Fluticasone for COPD. , 2016, The New England journal of medicine.

[11]  J. Remon,et al.  Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial. , 2014, British journal of clinical pharmacology.

[12]  Ruben D. Restrepo,et al.  Medication adherence issues in patients treated for COPD , 2008, International journal of chronic obstructive pulmonary disease.

[13]  F. Allaert,et al.  A prospective observational study of patient training in use of the autohaler inhaler device: the Sirocco study. , 2011, European review for medical and pharmacological sciences.

[14]  R. Reilly,et al.  The Clinical Impact of Different Adherence Behaviors in Patients with Severe Chronic Obstructive Pulmonary Disease , 2018, American journal of respiratory and critical care medicine.

[15]  Andrew R. Martin,et al.  Bridging the Gap Between Science and Clinical Efficacy: Physiology, Imaging, and Modeling of Aerosols in the Lung. , 2016, Journal of aerosol medicine and pulmonary drug delivery.

[16]  Niels H Chavannes,et al.  Clinical and economic impact of non-adherence in COPD: a systematic review. , 2014, Respiratory medicine.

[17]  D. Price,et al.  "Trying, But Failing" - The Role of Inhaler Technique and Mode of Delivery in Respiratory Medication Adherence. , 2016, The journal of allergy and clinical immunology. In practice.

[18]  J. Riley,et al.  Comparative Efficacy of Once-Daily Umeclidinium/Vilanterol and Tiotropium/Olodaterol Therapy in Symptomatic Chronic Obstructive Pulmonary Disease: A Randomized Study , 2017, Advances in Therapy.

[19]  A. Swensen,et al.  Treatment of COPD: relationships between daily dosing frequency, adherence, resource use, and costs. , 2011, Respiratory medicine.

[20]  I. Gich,et al.  Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? , 2016, Chest.

[21]  M. Dimatteo.  Variations in Patients’ Adherence to Medical Recommendations: A Quantitative Review of 50 Years of Research , 2004, Medical care.

[22]  Ala Szczepura,et al.  Report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO) , 2005 .

[23]  Ross T Tsuyuki,et al.  A meta-analysis of the association between adherence to drug therapy and mortality , 2006, BMJ : British Medical Journal.

[24]  J. George,et al.  Adherence to disease management programs in patients with COPD , 2007, International journal of chronic obstructive pulmonary disease.

[25]  C. Rand,et al.  Measuring adherence to asthma medication regimens. , 1994, American journal of respiratory and critical care medicine.

[26]  J. Cramer,et al.  Treatment persistence and compliance with medications for chronic obstructive pulmonary disease. , 2007, Canadian respiratory journal.

[27]  D. Price,et al.  The use of multiple respiratory inhalers requiring different inhalation techniques has an adverse effect on COPD outcomes , 2016, International journal of chronic obstructive pulmonary disease.

[28]  J. Bourbeau,et al.  Patient adherence in COPD , 2008, Thorax.

[29]  P. Dale,et al.  Qualitative assessment of attributes and ease of use of the ELLIPTA™ dry powder inhaler for delivery of maintenance therapy for asthma and COPD , 2013, BMC Pulmonary Medicine.

[30]  Anand A. Dalal,et al.  Association of chronic obstructive pulmonary disease maintenance medication adherence with all-cause hospitalization and spending in a Medicare population. , 2012, The American journal of geriatric pharmacotherapy.

[31]  Benedick.  Montreal Protocol on Substances that Deplete the Ozone Layer , 1996 .

[32]  P. Jones,et al.  Early onset of effect of salmeterol and fluticasone propionate in chronic obstructive pulmonary disease , 2005, Thorax.

[33]  M. Hiligsmann,et al.  Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review , 2017, npj Primary Care Respiratory Medicine.

[34]  N Moore,et al.  Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. , 2003, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[35]  Meilan K. Han,et al.  Once‐Daily Single‐Inhaler Triple versus Dual Therapy in Patients with COPD , 2018, The New England journal of medicine.

[36]  T. Brennan,et al.  Impact of Medication Adherence on Absenteeism and Short-Term Disability for Five Chronic Diseases , 2012, Journal of occupational and environmental medicine.

[37]  Jeffrey K Aronson,et al.  A new taxonomy for describing and defining adherence to medications. , 2012, British journal of clinical pharmacology.

[38]  Bartolome Celli,et al.  Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. , 2007, The New England journal of medicine.

[39]  H. Chrystyn,et al.  A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices , 2016, npj Primary Care Respiratory Medicine.

[40]  J. Fish,et al.  Level of asthma control and its impact on activities of daily living in asthma patients in Brazil* , 2013, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[41]  O. Usmani,et al.  Addressing the Impact and Unmet Needs of Nonadherence in Asthma and Chronic Obstructive Pulmonary Disease: Where Do We Go From Here? , 2018, The journal of allergy and clinical immunology. In practice.

[42]  Catherine Harvey,et al.  Effectiveness of Fluticasone Furoate-Vilanterol for COPD in Clinical Practice. , 2016, The New England journal of medicine.

[43]  M. V. Lopez Varela,et al.  Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study , 2017, PloS one.

[44]  M. Newhouse,et al.  Control of asthma by aerosols. , 1986, The New England journal of medicine.

[45]  Richard B. Reilly,et al.  Objective Assessment of Adherence to Inhalers by Patients with Chronic Obstructive Pulmonary Disease , 2017, American journal of respiratory and critical care medicine.

[46]  B. Vrijens,et al.  UvA-DARE ( Digital Academic Repository ) What We Mean When We Talk About Adherence in Respiratory Medicine , 2016 .

[47]  W. Bailey,et al.  Medication adherence patterns in chronic obstructive pulmonary disease. , 1991, Chest.

[48]  M. R. Siddiqui,et al.  Global Initiative for Chronic Obstructive Lung Disease (GOLD) , 2017 .

[49]  Arun Sivanandam,et al.  Evidence or Action , 2017 .

[50]  R. Perez-Padilla,et al.  Chronic obstructive pulmonary disease is underdiagnosed and undertreated in São Paulo (Brazil): results of the PLATINO study. , 2007, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[51]  TarragonaEduard,et al.  Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for Asthma and COPD Patients , 2016 .