Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study

Maria Montes de Oca, Ana Menezes, Fernando C Wehrmeister, Maria Victorina Lopez Varela, Alejandro Casas, Luis Ugalde, Alejandra Ramirez-Venegas, Laura Mendoza, Ana López, Filip Surmont, Marc Miravitlles, Maria Montes de Oca, Ana Menezes, Fernando C Wehrmeister, Maria Victorina Lopez Varela, Alejandro Casas, Luis Ugalde, Alejandra Ramirez-Venegas, Laura Mendoza, Ana López, Filip Surmont, Marc Miravitlles

Abstract

Background: This study assessed the adherence profiles to inhaled therapies and the agreement between two patient self-report adherence methods in stable COPD lpatients from seven Latin American countries.

Methods: This observational, cross-sectional, multinational, multicenter study involved 795 COPD patients (post-bronchodilator forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] <0.70). Adherence to inhaled therapy was assessed using the specific Test of Adherence to Inhalers (10-item TAI) and the generic 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaires. The percentage agreement and the kappa index were used to compare findings.

Results: 59.6% of patients were male (69.5±8.7 years); post-bronchodilator FEV1 percent predicted was 50.0±18.6%. Mean values for 10-item TAI and MMAS-8 questionnaires were 47.4±4.9 and 6.8±1.6, respectively. Based on the TAI questionnaire, 54.1% of patients had good, 26.5% intermediate, and 19.4% poor adherence. Using the MMAS-8 questionnaire, 51% had high, 29.1% medium, and 19.9% low adherence. According to both questionnaires, patients with poor adherence had lower smoking history, schooling but higher COPD Assessment Test score, exacerbations in the past-year and post-bronchodilator FEV1. The agreement between 10-item TAI and MMAS-8 questionnaires was moderate (Kappa index: 0.42; agreement: 64.7%).

Conclusion: Suboptimal adherence to medication was frequent in COPD patients from Latin America. Low adherence was associated with worse health status impairment and more exacerbations. There was inadequate agreement between the two questionnaires. Greater effort should be made to improve COPD patients' adherence to treatment, and assessment of adherence with more specific instruments, such as the TAI questionnaire, would be more convenient in these patients.

Clinical trial registration: NCT02789540.

Conflict of interest statement

Competing Interests: MMO: no real or perceived conflicts of interest. AM: Has been paid for her work as a statistician for the LASSYC study. FCW: no real or perceived conflicts of interest. MVLV: no real or perceived conflicts of interest. AC: no real or perceived conflicts of interest. LU: no real or perceived conflicts of interest. AR-V: no real or perceived conflicts of interest. LM: no real or perceived conflicts of interest. AL: no real or perceived conflicts of interest. FS: Employee of AstraZeneca. MM: no real or perceived conflicts of interest. This observational study was funded by AstraZeneca Latin America. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Patient adherence using the MMAS-8…
Fig 1. Patient adherence using the MMAS-8 and TAI questionnaires.
Fig 2. Proportion of patients in each…
Fig 2. Proportion of patients in each item of the TAI questionnaire according to response type (always, mostly, sometimes, rarely and never).

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