Adherence to treatment recommendations of patients with chronic non-communicable respiratory diseases – a narrative review
Adherence in asthma and COPD
Keywordschronic obstructive pulmonary disease (COPD), bronchial asthma, adherence, compliance, knowledge, narrative review
Despite modern therapeutic solutions, patients with chronic obstructive pulmonary disease (COPD) and asthma do not achieve therapeutic benefits due to emerging obstacles to compliance. This review aimed to present and analyze the results of available studies evaluating the influence of sociodemographic, clinical, and psychosocial factors on the level of adherence of patients with COPD and asthma. This narrative review was based on papers indexed in the following databases: PubMed, MEDLINE, CINAHL, Web of Science, and Scopus. The analyzed studies showed that the adherence level of patients with COPD and asthma is unsatisfactory, ranging from 23.6 to 80%. The main factors increasing the level of adherence of COPD patients mentioned in the analyzed studies were: unemployment, taking LAMA, not smoking cigarettes, belief that medication is necessary, higher education, use of multi-dose DPI and MDI inhalers, a greater sense of self-efficacy, and longer duration of disease. Independent determinants of good adherence of patients with asthma were better quality of life, high level of disease control, treatment with ICS + LABA or FF/UMEC/VI, good knowledge about asthma, and positive attitude towards the disease. According to available studies, determinants lowering adherence among patients with COPD were overweight or obesity, depression, poor quality of life, belief that treatment is harmful, frequent hospitalizations, lack of knowledge about the disease and treatment, sleep disorders, and use of ICS, LABA/ICS. Patients with asthma who received infrequent functional support consumed alcohol and were convinced of the harm and lack of need for treatment were non-adherent. In addition, an association was shown between high levels of adherence and a reduction in ED visits and hospitalizations in asthma and COPD patients.
The global burden of disease: 2004 update. https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf?sequence=1&isAllowed=y
Narodowy Fundusz Zdrowia. NFZ o zdrowiu. Astma. Centrala Narodowego Funduszu Zdrowia. Warszawa, 2020.
Samoliński B, Raciborski F, Lipiec A, Tomaszewska A, Krzych-Fałta E, Samel-Kowalik P, Walkiewicz A, Lusawa A, Borowicz J, Komorowski J, Samolińska-Zawisza U, Sybilski AJ, Piekarska B, Nowicka A. Epidemiology of allergic diseases in Poland. Polish Journal of Allergology 2014;1:10–18.
Venkatesan P. GOLD report: 2022 update. Lancet Respir Med. 2022;10(2):e20.
Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, Cruz AA, Duijts L, Drazen JM, FitzGerald JM, Fleming LJ, Inoue H, Ko FW, Krishnan JA, Levy ML, Lin J, Mortimer K, Pitrez PM, Sheikh A, Yorgancioglu AA, Boulet LP. Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes. Am J Respir Crit Care Med. 2022;205(1):17–35.
Jahnz-Różyk K, Kucharczyk A, Warchoł M, Radziwilska-Muc A, Władysiuk M, Plisko R. Koszty astmy w Polsce w 2012 roku. Pol. Merkur. Lek 2015;XXXIX(230):91–95.
Kardas P., Czeleko T., Śliwczyński A., Ciągłość i systematyczność leczenia astmy i POChP w Polsce – ocena przestrzegania zaleceń terapeutycznych na podstawie analizy krajowej bazy danych realizacji recept, Proceedings of The 10th International Conference of the Polish Pharmacoeconomics Society – ISPOR Poland Chapter, Warsaw 2012.
Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J. 2015;45(2):396-407.
Ismaila A, Corriveau D, Vaillancourt J, Parsons D, Stanford R, Su Z, Sampalis JS. Impact of adherence to treatment with fluticasone propionate/salmeterol in asthma patients. Curr Med Res Opin. 2014;30(7):1417–25.
Vestbo J, Anderson JA, Calverley PMA, Celli B, Ferguson GT, Jenkins C, Knobil K, Willits LR, Yates JC, Jones PW. Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax 2009;64(11):939–943.
Adherence to Long-Term Therapies - Evidence for Action. URL https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf?sequence=1&isAllowed=y
Baethge C, Goldbeck-Wood S, Mertens S. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5.
14.National Library of Medicine. Medical Subject Headings 2022. https://meshb.nlm.nih.gov
Kavanagh BP. The GRADE system for rating clinical guidelines. PLoS Med. 2009;6(9):e1000094.
Pierobon A, Sini Bottelli E, Ranzini L, Bruschi C, Maestri R, Bertolotti G, Sommaruga M, Torlaschi V, Callegari S, Giardini A. COPD patients' self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation. Int J Chron Obstruct Pulmon Dis. 2017;12:2059-2067.
Kjærgaard J, Juhl CB, Lange P, Wilcke T. Adherence to early pulmonary rehabilitation after COPD exacerbation and risk of hospital readmission: a secondary analysis of the COPD-EXA-REHAB study. BMJ Open Respir Res. 2020;7(1):e000582.
Kokturk N, Polatli M, Oguzulgen IK, Saleemi S, Al Ghobain M, Khan J, Doble A, Tariq L, Aziz F, El Hasnaoui A. Adherence to COPD treatment in Turkey and Saudi Arabia: results of the ADCARE study. Int J Chron Obstruct Pulmon Dis. 2018;13:1377–1388.
Albrecht JS, Khokhar B, Huang TY, Wei YJ, Harris I, Moyo P, Hur P, Lehmann SW, Netzer G, Simoni-Wastila L. Adherence and healthcare utilization among older adults with COPD and depression. Respir Med. 2017;129:53–58.
Kaye L, Gondalia R, Thompson A, Stempel DA, Barrett MA. The relationship between objective app engagement and medication adherence in asthma and COPD: a retrospective analysis. Sci Rep. 2021;11(1):24343.
Criner GJ, Cole T, Hahn KA, Kastango K, Eudicone J, Gilbert I. The Impact of Budesonide/Formoterol pMDI Medication Reminders on Adherence in Chronic Obstructive Pulmonary Disease (COPD) Patients: Results of a Randomized, Phase 4, Clinical Study. Int J Chron Obstruct Pulmon Dis. 2021;16:563-577.
Farias R, Sedeno M, Beaucage D, Drouin I, Ouellet I, Joubert A, Abimaroun R, Patel M, Abou Rjeili M, Bourbeau J. Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence. BMJ Open Respir Res. 2019;6(1):e000379.
Montes de Oca M, Menezes A, Wehrmeister FC, Lopez Varela MV, Casas A, Ugalde L, Ramirez-Venegas A, Mendoza L, López A, Surmont F, Miravitlles M. Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study. PLoS One. 2017 Nov 15;12(11):e0186777.
Homętowska H, Świątoniowska-Lonc N, Klekowski J, Chabowski M, Jankowska-Polańska B. Treatment Adherence in Patients with Obstructive Pulmonary Diseases. Int J Environ Res Public Health. 2022 Sep 14;19(18):11573.
López-Pintor E, Grau J, González I, Bernal-Soriano MC, Quesada JA, Lumbreras B. Impact of patients' perception of COPD and treatment on adherence and health-related quality of life in real-world: Study in 53 community pharmacies. Respir Med. 2021;176:106280.
Abdulsalim S, Unnikrishnan MK, Manu MK, Alrasheedy AA, Godman B, Morisky DE. Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study. Res Social Adm Pharm. 2018;14(10):909–914.
Nguyen TS, Nguyen TLH, Pham TTV, Hua S, Ngo QC, Li SC. Impact of pharmaceutical care in the improvement of medication adherence and quality of life for COPD patients in Vietnam. Respir Med. 2019;153:31–37.
Jouleh B, Erdal M, Eagan TM, Bakke P, Gulsvik A, Nielsen R. Guideline adherence in hospital recruited and population based COPD patients. BMC Pulm Med. 2018;18(1):195.
Scalone G, Nava S, Ventrella F, Bussoli G, Catapano GA, Pennisi A, Dadduzio F, Schino P, Pela R, Bartezaghi M, Morini P, Porpiglia PA, Muscianisi E; Mistral study group. Pharmacological approach and adherence to treatment recommendations in frequently and non-frequently exacerbating COPD patients from Italy: MISTRAL - The prospective cohort, observational study. Pulm Pharmacol Ther. 2018;53:68–77.
Polański J, Chabowski M, Świątoniowska-Lonc N, Mazur G, Jankowska-Polańska B. Medication Compliance in COPD Patients. Adv Exp Med Biol. 2020;1279:81–91.
Palmiotti GA, Lacedonia D, Liotino V, Schino P, Satriano F, Di Napoli PL, Sabato E, Mastrosimone V, Scoditti A, Carone M, Costantino E, Resta E, Attolini E, Foschino Barbaro MP. Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. Int J Chron Obstruct Pulmon Dis. 2018;13:2455–2462.
Moy ML, Harrington KF, Sternberg AL, Krishnan JA, Albert RK, Au DH, Casaburi R, Criner GJ, Diaz P, Kanner RE, Panos RJ, Stibolt T, Stoller JK, Tonascia J, Yusen RD, Tan AM, Fuhlbrigge AL; LOTT Research Group. Characteristics at the time of oxygen initiation associated with its adherence: Findings from the COPD Long-term Oxygen Treatment Trial. Respir Med. 2019;149:52–58.
Qin R, Liu Z, Zhou X, Cheng A, Cui Z, Li J, Wei X, Xiao D, Wang C. Adherence and Efficacy of Smoking Cessation Treatment Among Patients with COPD in China. Int J Chron Obstruct Pulmon Dis. 2021;16:1203–1214.
Park TS, Kang J, Lee JS, Oh YM, Lee SD, Lee SW. Adherence to roflumilast under dose-escalation strategy in Korean patients with COPD. Int J Chron Obstruct Pulmon Dis. 2019;14:871–879.
Federman AD, O'Conor R, Wolf MS, Wisnivesky JP. Associations of Medication Regimen Complexity with COPD Medication Adherence and Control. Int J Chron Obstruct Pulmon Dis. 2021;16:2385–2392.
Chan KP, Ko FW, Chan HS, Wong ML, Mok TY, Choo KL, Hui DS. Adherence to a COPD treatment guideline among patients in Hong Kong. Int J Chron Obstruct Pulmon Dis. 2017;12:3371–3379.
Mueller S, Wilke T, Bechtel B, Punekar YS, Mitzner K, Virchow JC. Non-persistence and non-adherence to long-acting COPD medication therapy: A retrospective cohort study based on a large German claims dataset. Respir Med. 2017;122:1–11.
Bollmeier SG, Seaton TL, Prosser TR, Chou YT, Reckenberg K, Hahn B, Stanford RH, Ray R. Assessment of symptom burden and adherence to respiratory medications in individuals self-reporting a diagnosis of COPD within a community pharmacy setting. J Am Pharm Assoc (2003). 2019;59(4):479–488.
Alahmadi FH, Simpson AJ, Gomez C, Ericsson M, Thörngren JO, Wheelock CE, Shaw DE, Fleming LJ, Roberts G, Riley J, Bates S, Sousa AR, Knowles R, Bansal AT, Corfield J, Pandis I, Sun K, Bakke PS, Caruso M, Chanez P, Dahlén B, Horvath I, Krug N, Montuschi P, Singer F, Wagers S, Adcock IM, Djukanovic R, Chung KF, Sterk PJ, Dahlen SE, Fowler SJ; U-BIOPRED Study Group. Medication Adherence in Patients With Severe Asthma Prescribed Oral Corticosteroids in the U-BIOPRED Cohort. Chest. 2021;160(1):53–64.
Bassam M, Behbehani N, Farouk H, Alsayed M, Montestruc F, Al-Jahdali H, Iqbal MN, Al Zaabi A. Adherence to medication among adult asthma patients in the Middle East and North Africa: results from the ESMAA study. Respir Med. 2021;176:106244.
Busse WW, Abbott CB, Germain G, Laliberté F, MacKnight SD, Jung Y, Duh MS, Averell CM. Adherence and Persistence to Single-Inhaler Versus Multiple-Inhaler Triple Therapy for Asthma Management. J Allergy Clin Immunol Pract. 2022;10(11):2904–2913.
Heluf H, Assefa N, Dessie Y, Tamiru D, Goshu AT, Fekadu G.Adherence to anti-asthma medications among adult asthmatic patients in Eastern Ethiopia: A multi-center cross-sectional study. PLoS One. 2022;17(12):e0277796.
Mohd Isa NA, Cheng CL, Nasir NH, Naidu V, Gopal VR, Alexander AK. Asthma control and asthma treatment adherence in primary care: results from the prospective, multicentre, non-interventional, observational cohort ASCOPE study in Malaysia. Med J Malaysia. 2020;75(4):331–337.
Baldacci S, Simoni M, Maio S, Angino A, Martini F, Sarno G, Cerrai S, Silvi P, Pala AP, Bresciani M, Paggiaro P, Viegi G; ARGA Collaborative Group. Prescriptive adherence to GINA guidelines and asthma control: An Italian cross sectional study in general practice. Respir Med. 2019;146:10–17.
Takala J, Vähätalo I, Tuomisto LE, Niemelä O, Ilmarinen P, Kankaanranta H. Participation in scheduled asthma follow-up contacts and adherence to treatment during 12-year follow-up in patients with adult-onset asthma. BMC Pulm Med. 2022;22(1):63.
Jácome C, Almeida R, Pereira AM, Amaral R, Mendes S, rt al. Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study. JMIR Mhealth Uhealth. 2021;9(5):e26442.
Dima AL, van Ganse E, Stadler G, de Bruin M; ASTRO-LAB group; Members of the ASTRO-LAB group were:. Does adherence to inhaled corticosteroids predict asthma-related outcomes over time? A cohort study. Eur Respir J. 2019;54(6):1900901.
Raebel MA, Shetterly SM, Goodrich GK, Anderson CB, Bender BG, Wagner NM. Refill Reminder Preference and Inhaled Corticosteroid Adherence Among Patients with Asthma. Perm J. 2020;24:1–8.
Cvietusa PJ, Wagner NM, Shoup JA, Goodrich GK, Shetterly SM, King DK, Raebel MA, Riggs CS, Bender B. Digital Communication Technology: Does Offering a Choice of Modality Improve Medication Adherence and Outcomes in a Persistent Asthma Population? Perm J. 2020;25:1.
Paoletti G, Keber E, Heffler E, Malipiero G, Baiardini I, Canonica GW, Giua C; SIFAC Group of Clinical community Pharmacists (SGCP). Effect of an educational intervention delivered by pharmacists on adherence to treatment, disease control and lung function in patients with asthma. Respir Med. 2020;174:106199.
Sulaiman I, Greene G, MacHale E, Seheult J, Mokoka M, D'Arcy S, Taylor T, Murphy DM, Hunt E, Lane SJ, Diette GB, FitzGerald JM, Boland F, Sartini Bhreathnach A, Cushen B, Reilly RB, Doyle F, Costello RW. A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma. Eur Respir J. 2018;51(1):1701126.
O'Conor R, Hebert-Beirne J, Kwasny M, Eldeirawi K, Hasnain-Wynia R, Wisnivesky J, Wolf M, Federman A. Structural and functional support among US older adults with asthma: cross-Sectional associations with medication adherence. BMJ Open. 2019;9(8):e027430.
Norful AA, Bilazarian A, Chung A, George M. Real-world Drivers Behind Communication, Medication Adherence, and Shared Decision Making In Minority Adults with Asthma. J Prim Care Community Health. 2020;11:2150132720967806.
Exarchos KP, Rovina N, Krommidas G, Latsios D, Gogali A, Kostikas K. Adherence and quality of life assessment in patients with asthma treatment with budesonide/formoterol via the Elpenhaler device: the COMPLETE study. BMC Pulm Med. 2022;22(1):254.
Toyama T, Kawayama T, Kinoshita T, Imamura Y, Yoshida M, Takahashi K, Fujii K, Higashimoto I, Hoshino T. Differences in Adherence Barriers to Inhaled Medicines between Japanese Patients with Chronic Obstructive Pulmonary Disease and Asthma Evaluated using the "Adherence Starts with Knowledge 20" (ASK-20) Questionnaire. Intern Med. 2019;58(2):175–185.
Smits D, Brigis G, Pavare J, Maurina B, Barengo NC. Factors related to good asthma control using different medical adherence scales in Latvian asthma patients: an observational study. NPJ Prim Care Respir Med. 2017;27(1):39.
Averell CM, Laliberté F, Germain G, Duh MS, Rousculp MD, MacKnight SD, Slade DJ. Impact of adherence to treatment with inhaled corticosteroids/long-acting β-agonists on asthma outcomes in the United States. Ther Adv Respir Dis. 2022;16:17534666221116997.
Ramsahai JM, King E, Niven R, Tavernier G, Wark PAB, Simpson JL. Serum prednisolone levels as a marker of oral corticosteroid adherence in severe asthma. BMC Pulm Med. 2020;20(1):228.
Papi A, Ryan D, Soriano JB, Chrystyn H, Bjermer L, Rodríguez-Roisin R, Dolovich MB, Harris M, Wood L, Batsiou M, Thornhill SI, Price DB. Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol Pract. 2018;6(6):1989–1998.
How to Cite
Copyright (c) 2023 Henryka Homętowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Number of views and downloads: 175
Number of citations: 0