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


In our retrospective data analysis, we were able to show that adherence to inhaled therapy in COPD patients is generally low. Complete adherence to inhaled therapy was only seen in 33.6%. Factors associated with better adherence were age, former smoking, and more severe airflow limitation.

In prior studies adherence in COPD ranged between 70 to 90% in several clinical trials; however, in clinical practice, adherence is lower within the range of 10–40%, irrespective of the probable insufficient or incorrect use of the device.[15,26,27]

We could show that adherence to inhaled therapy was higher in GOLD spirometry class III – IV COPD and was highest in patients with GOLD spirometry class IV COPD. This may be due to the fact, that with advanced disease and a higher burden of symptoms, the inhaled medication is perceived more necessary by the patient. The association between symptom relief and medication use may be a potent trigger for better adherence.[16] Contrariwise, lack of clinical symptoms can be misinterpreted and can lead to treatment interruption and cessation.[26] This is in accordance with previous studies, where adherence was better in patients with more severe disease.[28,29]

In our univariate and multivariate analysis, the risk of exacerbations leading to hospitalization was more than 10-fold higher in GOLD stage IV compared to GOLD stage I. Patients with low adherence tended to have a reduced risk for exacerbations leading to hospitalization (OR 0.58; 0.33, 1.02; not significant in multivariate analysis).

In previous research, better adherence in COPD patients was associated with a reduced risk for exacerbations and health care utilization.[18,30]

This paradoxical result may be caused by other influencing factors as this trend was considerably less pronounced and statistically not significant in multivariate compared to univariate analysis. Furthermore, the nonadherent patients predominately had GOLD spirometry class I – II COPD with less impairment of lung function, probably less symptoms and better quality of life.

Adherence in COPD patients is complex and multiple factors may be influencing. Parameters associated with poor adherence include the dosing regime, drug side effects, comorbidities, age and costs, the patient's disease perception but also social factors.[14,15,23]

Possibilities to improve adherence include knowledge about self-management, overcoming misperceptions, close communication and shared decision-making between patients and their physicians, simple therapy regimes and low out-of-pocket costs for medications.[13,18,23,26,31–33]