Nonadherence in chronic obstructive pulmonary disease patients

Abstract

Purpose of reviewAlthough nonadherence research in patients with chronic obstructive pulmonary disease (COPD) lags well behind other diseases, new evidence helps inform understanding about the degree and underlying causes of patient nonadherence, interventions that can improve adherence, and areas of research needed to further progress in improving this problem in patients with COPD. Recent findingsFewer than half of treatments for COPD, including oxygen supplementation, physical rehabilitation, and medication, are taken as prescribed. Most patients abandon their treatment after an initial start. Nonadherence in turn contributes to rising rates of hospitalization, death, and healthcare costs. The reasons why patients choose not to use their COPD treatments are not fully understood, although depression is clearly a contributing factor. Although a substantial number of studies have tested adherence interventions, few have included COPD patients or addressed polypharmacy in patients with multiple comorbidities. SummaryThe paucity of research does not reflect the inadequacy of available treatments. Lessons learned from the research outside of COPD and a small number of COPD studies suggest that a collaborative care approach will likely provide the most potential for improving overall care, including management of depression and enhancement of adherence. Exploitation of mobile telephone technology to engage patients in a discussion of their self-care should not be ignored as a potential intervention for COPD patients.

Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention

“…For eHealth self-management apps, we found user evaluation studies for diabetes [ 29 - 31 ] and dementia [ 32 ]. Bender et al [ 33 ] performed a systematic review on mobile phone apps for the prevention, detection, and management of cancer. They concluded that even though there are hundreds of cancer-focused apps, there is a lack of evidence on their utility, effectiveness, and safety.…”

Estimating the effectiveness of pulmonary rehabilitation for COPD exacerbations: reduction of hospital inpatient days during the following year

“…In a review published in 2014, the finding was that the adherence to PR is about the same as to medication, that is, 50%. 18 COPD patients’ socioeconomic status is often low, and the expenses of the pulmonary clinic’s PR course, including the rather high transportation costs (varying up to 440–640€ if taxi or invalid taxi was needed), might be a meaningful limitation for participation. 19 To lower the expenses and assure the availability for everyone, the PR courses and the personalized training activities should be organized at several sites closer to the patients’ homes.…”

Effectiveness of a pharmacist-driven intervention in COPD (EPIC): study protocol for a randomized controlled trial

“…COPD management in Canada remains suboptimal, with significant care gaps and patients experiencing poor outcomes and high exacerbation rates [ 40 ]. COPD has received considerably less attention in adherence research than asthma, diabetes, cardiovascular disease, and other chronic health conditions [ 41 ]. Thus, there is a need for additional evidence with regards to therapy adherence in COPD patients.…”