Evaluation of medication adherence and inhaler technique in patients with COPD; a cross-sectional study

Introduction: It is predicted that chronic obstructive pulmonary disease (COPD) will become the fourth leading cause of death worldwide by 2030. Patients’ adherence to medications and correct inhaler technique in COPD is essential to optimize disease management. The aim of the presentstudy was to evaluate the medication adherence and inhaler technique in a sample of patients with COPD. Methods: This observational study recruited COPD outpatients at the pulmonary clinic of Imam Khomeini Hospital complex, Tehran, Iran. Patients with COPD who received at least one inhaler on a scheduled basis were included. The validated Persian version of Morisky Medication Adherence scale (MMAS) was usedto measure adherence to inhaler medications. Inhaler technique was evaluated using a separate validated checklist for each inhaler. The checklists were developed based on the drug leaflets, previous articles, patients educational materials and other resources. The validity of the checklists were examined by the expert panel consisting of clinical pharmacists and pulmonologists. Patients’ inhaler technique wasevaluated while they used a sample inhaler. Results and Discussion: Totally, 175 patients were included (mean age 59 years, 42.3% females). We found that 39.4% of patients had a low adherence (MMAS score< 6) to their inhaler medications. Patients’ devices consisted of 192(62.3%) MDI/MDI with spacer and 116 (37.6%) DPI devices. We noted that 37.7% of patients had > 30% error. The most frequent errors wereobserved in patient who used MDI plus spacer. Patients with a higher educational degree had a significantly lower average rate of errors (P=0.001). Conclusions: The results indicated that the non-adherence and improper inhalation technique was frequent in patients with COPD and due to the high burden of the disease, interventions are warranted.

Keywords:

Medication Adherence , Chronic Obstructive Pulmonary Disease , Inhaler Technique ,