New insights to improve treatment adherence in asthma and COPD

Maureen George, Bruce Bender, Maureen George, Bruce Bender

Abstract

Chronic respiratory diseases such as asthma and COPD are typically managed by daily inhaled medication. However, the efficacy of an inhaled medication depends upon a patient's adherence to therapy, which refers to whether the medication is actually taken as prescribed. In patients with these diseases, higher adherence has been associated with better health outcomes, such as improved disease control and a reduction in severe and potentially costly exacerbations. Adherence is a multifaceted concept that includes medication-related, intentional, and unintentional reasons that patients may or may not take their medication as directed. The purpose of this integrative review is to present the individual patient factors that contribute to suboptimal adherence to inhaled therapies and the associated effects on health outcomes, while also highlighting evidence-based strategies for health care providers to improve adherence to such therapies in patients with asthma or COPD. Working closely with patients to establish a model of shared decision-making, which takes patient beliefs and preferences into account when choosing treatment options, has the potential to improve adherence and overall patient outcomes in the management of asthma and COPD.

Keywords: chronic disease; evidence-based medicine; health behavior; inhalers.

Conflict of interest statement

MG has served as a consultant for AstraZeneca and Teva. MG also reports personal fees from Teva and AstraZeneca, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Factors contributing to suboptimal adherence in asthma and COPD. The factors that contribute to suboptimal adherence in asthma and COPD are grouped into 3 major categories. Notes: Image: iStock.com/Alessandro2802. Data from Global initiative for asthma  http://www.ginasthma.org; Makela et al; Bryant et al and van Boven. Abbreviations: COPD, chronic obstructive pulmonary disease; HCP, health care provider.
Figure 2
Figure 2
Strategies for improving adherence to inhaled medications for asthma and COPD. A multifaceted care plan tailored to an individual patient can improve adherence and, ultimately, health outcomes. Notes: Upper left image: iStock.com/Vesnaandjic. Upper right image reprinted from The Lancet, Vol. 3, No. 3, Chan AH, Stewart AW, Harrison J, Camargo CA, Black PN, Mitchell EA, The effect of an electronic monitoring device with audiovisual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: a randomised controlled trial, p210-219, Copyright 2015, with permission from Elsevier. Bottom left image: iStock.com/Steve Debenport. Bottom right image: iStock.com/DragonImages. Data from Tommelein et al Wilson et aland Chan et al. Abbreviations: COPD, chronic obstructive pulmonary disease; HCP, health care provider.

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