Relationship Between Medication Adherence and Health-Related Quality of Life in Subjects With COPD: A Systematic Review

Abstract

BACKGROUND: Various aspects of medication adherence and health-related quality of life (HRQOL)have been studied in subjects with COPD. Nevertheless, little is known about the association between these factors. The aim of this study was to undertake a systematic review of the published literature focusing on the relationship between medication adherence and HRQOL in COPD. METHODS: A systematic literature search of English language articles was conducted in April 2013 using MEDLINE. No publication date limits were defined. All of the included studies were assessed for quality. RESULTS: Seven studies were included in the review. Three of the assessed studies found no correlation, and 3 studies described positive and 2 studies reported negative associations between medication adherence and HRQOL. The results indicate that an improved HRQOL may be a trigger for non-adherence in patients with COPD. CONCLUSIONS: The relationship between medication adherence and HRQOL may be dual. The effect of medication adherence on HRQOL might be a consequence of the effectiveness of therapy and the negative effects (ie, side effects, daily life limitation of therapy, social stigma) that it can generate. HRQOL might also influence the patterns of patients' drug use, as an increased HRQOL might trigger non-adherence. The dynamics between adherence and HRQOL might differ over time, as the negative effects of medication non-adherence might become dominant in the long term.

Age-Related Differences in Antihypertensive Medication Adherence in Hispanics: A Cross-Sectional Community-Based Survey in New York City, 2011–2012

“…Consistent with findings of some other studies, our finding was that those with better self-rated general health had a lower prevalence of adherence, suggesting that in younger adults, self-appraisal of general health as “excellent” or “very good” may trigger nonadherence, possibly given that many in this age group have not developed physical CVD symptoms yet (28,29). Conversely, recent poor physical health also predicted a lower prevalence of high adherence, suggesting that physical disease symptoms may be associated with reduced adherence.…”

“…Conversely, recent poor physical health also predicted a lower prevalence of high adherence, suggesting that physical disease symptoms may be associated with reduced adherence. Therefore, different domains of HRQOL may have distinct influences on adherence in younger adults, and future research must explicitly understand the mechanisms by which specific aspects of HRQOL influence adherence in this age group (29,30). In older adults, both poor physical health and poor health–related activity limitation were associated with lower prevalence of adherence, indicating that aging-related physical health symptoms and associated disabilities may be important barriers to adherence in older populations.…”

“…On the other hand, in both younger and older adults, recent poor mental HRQOL was significantly related to high adherence in bivariable but not in adjusted analyses. Although prior research has been largely inconsistent regarding the role of mental health HRQOL measures in predicting adherence (29,30), clinical measures of mental health (eg, depression, depressive symptoms) have consistently been documented as predictors of adherence (6), including among Hispanics (28). Future research must delineate the relevance of specific measures of mental health (HRQOL measures vs clinical measures) in relation to adherence.…”

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

“…Consistent with previous reviews, we found no clear association between non‐adherence and QoL . In a review specific to COPD medications, only 1 of the included studies measured the impact of adherence to nebulizers over a 4‐week period, finding that adherence was negatively correlated with disease‐specific HRQoL, measured at the end of the study .…”

“…In a review specific to COPD medications, only 1 of the included studies measured the impact of adherence to nebulizers over a 4‐week period, finding that adherence was negatively correlated with disease‐specific HRQoL, measured at the end of the study . The relationship between adherence and QoL can be influenced by many factors such as disease severity, cognitive functioning and the patient's understanding of their medication regimen . Therefore, to truly understand the complex relationship between adherence and QoL, multivariable regression analyses should be conducted, which were absent in most of the QoL studies included in this review.…”