Adherence to Inhaled Therapy and Its Impact on Chronic Obstructive Pulmonary Disease (COPD)

Magdalena Humenberger; Andreas Horner; Anna Labek; Bernhard Kaiser; Rupert Frechinger; Constanze Brock; Petra Lichtenberger; Bernd Lamprecht


BMC Pulm Med. 2018;18(163) 

In This Article


Chronic obstructive pulmonary disease (COPD) is an underdiagnosed, preventable and treatable disease with increasing prevalence worldwide. It has been a major problem over decades and will be a challenge within the twenty-first century.[1–4]

To reduce mortality in COPD patients, lower the economic and clinical burden and to improve quality of life, it is crucial to prevent disease progression, reduce exacerbation rates and focus on the treatment of comorbidities.[5–9] Adherence to inhaled therapy appears to have significant impact on treatment goals. Therefore, it is crucial to increase the patients' and physicians' awareness concerning this topic.

Only few data are available on adherence and influencing factors. A meta-analysis of over 50 years of research on adherence shows an association between adherence and social and emotional resources.[10,11] In a study of patients including those with COPD by Balkrishnan et al., the numbers of hospitalization rates and physician visits were reduced in patients who were adherent to prescribed therapy.[12]

Nonadherence is a tremendous problem in the treatment of patients in general.[13] Furthermore, adherence in COPD patients is particularly poor and reported nonadherence rates range from 50 to 80%.[14–16]

In patients with COPD, nonadherence to inhaled therapy is caused by several factors and could lead to high mortality and morbidity as well as hospitalizations and a reduced quality of life.[14,17–21] Thus, the consequences of nonadherence, clinically and economically, are neither completely obvious nor fully understood, but there is an association between nonadherence and increasing healthcare costs.[17,19,22,23]

The aim of this retrospective data analysis was to evaluate the association of the stage of COPD on adherence and the relationship between adherence and COPD exacerbations. We hypothesized, that better adherence is associated with less COPD exacerbations leading to hospitalization.