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Adherence to COPD treatment: Myth and reality
Open accessAbstract
COPD is a chronic disease in which effective management requires long-term adherence to pharmacotherapies but the level of adhesion to the prescribed medications is very low and this has a negative influence on outcomes. There are several approaches to detect non-adherence, such as pharmacy refill methods, electronic monitoring, and self-report measures, but they are all burdened with important limitations. Medication adherence in COPD is multifactorial and is affected by patients (health beliefs, cognitive abilities, self-efficacy, comorbidities, psychological profile, conscientiousness), physicians (method of administration, dosing regimen, polypharmacy, side effects), and society (patient-prescriber relationship, social support, access to medication, device training, follow-up). Patient-health care professional communication, especially that between patient and physician or pharmacist, is central to optimizing patient adherence. However, the most realistic approach is to keep in mind that non-adherence is always possible, indeed, probable.
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“Previous studies suggested that the misuse or rejection of medication or NIV can be influenced by some psychological factors such as anxiety, depression, health beliefs, and cognitive impairment (27–29); the unacknowledged recognition of the illness; and the use of different devices and medications due to comorbidities (30–32).”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [29]
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Cited by
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“Nevertheless, the documentation that in COPD [3] adherence to inhalation medication is device-related is sufficient on its own to highlight the importance of the device in therapeutic adherence [4].”
BackgroundSelf-citationDoxofylline is not just another theophylline!
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“There are now a bewildering array of inhaled devices and formulations of drugs available for the treatment of asthma and COPD, which are often associated with poor adherence.(49,50) Thus, the use of an orally active drug that is safe, effective and relatively inexpensive is to be encouraged, particularly for patients…”
Self-citationInhaler Adherence in COPD: A Crucial Step Towards the Correct
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BackgroundEffects of a COPD self-management support intervention: a randomized controlled trial
Bringsvor, H., Langeland, E., Oftedal, B., Skaug, K., Assmus, J., & Bentsen, S. (2018) · International Journal of COPD · doi:10.2147/copd.s181005 · Cited by 36
Pharmacotherapies in Older Adults with COPD: Challenges and Opportunities
Matera, M. G., Hanania, N. A., Maniscalco, M., & Cazzola, M. (2023) · Drugs & Aging · doi:10.1007/s40266-023-01038-0 · Cited by 40
“It is necessary to develop interventions that address adherence barriers specific to older patients (such as cognition, polypharmacy, and immobility), identify strategies for continuous inhaler technique support outside of the professional healthcare setting, and assess the impact of prescribing multiple types of inha…”
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Sex differences in COPD management
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BackgroundSelf-citationTraining Specificity of Inspiratory Muscle Training Methods: A Randomized Trial
Hollebeke, M. V., Gosselink, R., & Langer, D. (2020) · Frontiers in Physiology · doi:10.3389/fphys.2020.576595 · Cited by 27
Motivation und Diabetes – Zeit für einen Paradigmenwechsel? – Ein Positionspapier –
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Baiardini, I., Novakova, S. M., Mihaicuta, S. D., Oğuzülgen, İ. K., & Canonica, G. W. (2018) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2019.1554438 · Cited by 26
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Ščurek, M., & Brat, K. (2024) · Journal of Thoracic Disease · doi:10.21037/jtd-23-1781 · Cited by 24
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Donner, C. F., Amaducci, S., Bacci, E., Baldacci, S., Bartoli, M. L., Beghi, G. M., Benfante, A., Brighindi, S., Casali, L., Castiglia, D., et al. (2018) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2018.886 · Cited by 21
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Self-citationVytrisalova, M., Hendrychova, T., Touskova, T. P., Zimčíková, E., Vlček, J., Nevoránek, L., Svoboda, M., Hejduk, K., Brat, K., Plutinský, M., et al. (2019) · Frontiers in Pharmacology · doi:10.3389/fphar.2019.00241 · Cited by 21
Factors Affecting Patient Adherence to Inhalation Therapy: An Application of SEIPS Model 2.0
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“Moreover, the quality of communication between patients and HCPs can also contribute.(14) For example, patients can misunderstand prescriptions due to suboptimal communication with their HCPs, which could lead to accidental non-adherence.”
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Węziak‐Białowolska, D., Białowolski, P., & Niemiec, R. M. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.114494 · Cited by 26
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Papi, A. A., Avdeev, S. N., Calverley, P. M. A., Cordeiro, C. R., Jeseňák, M., Koblížek, V., Petkova, D., Rogliani, P., Tarraf, H., Tzanakis, Ν., et al. (2020) · Respiratory Medicine · doi:10.1016/j.rmed.2020.106190 · Cited by 15
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Nguyen, T. N., Truong, M. T. X., Lam, D. N., Nguyen, H. T. T., Huynh, A. M., Duong, V. K., Vo, T. P. M., Nguyen, T. H. P., Cao, T. T. M., Pham, S. T., et al. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.108037 · Cited by 14
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Primary non-adherence to inhaled medications measured with e-prescription data from Poland
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“One of the most significant problems facing healthcare today is poor medication adherence.(1) Although many factors contribute to poor adherence to medications, a significant portion of adherence issues can be attributed to the high cost of medications.”
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“Therefore, building good relationships and communication with patients is essential to improve adherence.(55)”
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Kahle‐Wrobleski, K., Bui, B. K. H., Friderici, J. L., Moore, K., Carlyle, M. H., Webb, N. S., Martin, C. K., Pace, W. D., & Westfall, J. M. (2024) · International Journal of COPD · doi:10.2147/copd.s454877 · Cited by 4
“16,17 However, physicians in this study still prioritized the clinical characteristics of the patients over cost when making specific decisions in response to the vignettes.”
BackgroundThe influence of gender differences on the illness perception and women’s point of view on COPD
Janković, J., Djurdjevic, N., Jandrić, A., Karić, U., Milivojević, I., Ratkovic, A., & Buha, I. (2023) · Bratislavské lekárske listy/Bratislava medical journal · doi:10.4149/bll_2023_122 · Cited by 4
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Tichopád, A., Zigmond, J., Jeseňák, M., Solovič, I., Breciková, K., Rybář, M., Rožánek, M., & Sedlák, V. (2024) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2023-001874 · Cited by 4
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“17 However, as it remains difficult to understand non-adherence behavior, improving the outcomes of COPD patients can be challenging.”
BackgroundICS/Ultra LABA in the Treatment of Obstructive Airway Diseases: A Consensus of Indian Experts
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BackgroundTratamentos utilizados por portadores de DPOC no Brasil: Pesquisa Nacional de Saúde, 2013
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“Medication adherence in COPD is generally low and appears unrelated to sex (Matera et al., 2021; Rogliani et al., 2017).”
Self-citationŢîrcă, S. M., Ciontea, M. S., Vlad, E., & Mihaltan, F. D. (2021) · Internal Medicine · doi:10.2478/inmed-2021-0155 · Cited by 3
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“Other reported approaches are electronic monitors, canister weighing, analysis of pharmacy records, and the ratio of doses taken/doses prescribed [30].”
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Revue générale sur l’adhésion aux traitements inhalés de la BPCO
Dalon, F., Ganse, E. H. V., Silva, C. C. D., Nachbaur, G., Sail, L., & Belhassen, M. (2019) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2019.06.005 · Cited by 3
“, 51,2 % des patients ont reporté De nombreux facteurs sont associés à une mauvaise adhésion thérapeutique [22].”
BackgroundInfluentialAsthma and COPD: Comparison with International Guidelines and Medication Adherence in Belgium
Biset, N., Lelubre, M., Pochet, S., & Vriese, C. D. (2023) · Pharmaceuticals · doi:10.3390/ph16071030 · Cited by 2
“, to a cheaper generic, could also be detrimental to adherence [59].”
BackgroundYohannes, A. M., Iyer, A. S., Clay, C., Cochran, L. W., Chen, X., Lombardi, D. A., & Bhatt, S. P. (2024) · Chronic Obstructive Pulmonary Diseases Journal of the COPD Foundation · doi:10.15326/jcopdf.2023.0465 · Cited by 2
Tschenett, H., Funk, G., Vafai-Tabrizi, F., & Nater, U. M. (2024) · Mindfulness · doi:10.1007/s12671-024-02387-6 · Cited by 3
“This is especially relevant for the COPD population, which is a highly impaired, hard-to-reach group with often poor treat-ment adherence (Rogliani et al., 2017).”
An Overview and Management of Multiple Chronic Conditions
Akarsu, S. (2020) · IntechOpen eBooks · doi:10.5772/intechopen.83051 · Cited by 2
Jelić, I., Folić, M., Mihajlović, F., Јаnkovic, S., & Mihajlović, G. (2022) · EABR. Experimental and Applied Biomedical Research · doi:10.2478/sjecr-2021-0068 · Cited by 2
“Adherence to prescribed medication is crucial for the beneficial outcome of treatment in COPD patients [20].”
BackgroundVideo Education Program for Proper use of Inhalation Devices in Elderly COPD Patients
Zhu, H. Y., Qin, S., & Wu, M. C. (2023) · Clinical and investigative medicine · doi:10.25011/cim.v46i2.40272 · Cited by 2
Zimmermann, M., Kroppen, D., Ammous, O., Majorski, D. S., Berger, M., Stanzel, S. B., Holle, J. F., Schumacher, F., Matthes, T., Windisch, W., et al. (2026) · BMC Pulmonary Medicine · doi:10.1186/s12890-026-04102-8 · Cited by 1
Stigma towards Patients with Chronic Obstructive Pulmonary Disease: To Help or To Judge?
Khan, I. A. (2021) · Biomedical Research and Clinical Reviews · doi:10.31579/2692-9406/063 · Cited by 1
Zhao, Y., Ma, Y., Geng, L., Nie, J., Yu, X., Kang, Z., Liu, Y., & Su, Y. (2025) · International Journal of COPD · doi:10.2147/copd.s500502 · Cited by 1
“9,18 The emotional toll of such beliefs is evident in the higher levels of anxiety and depression reported among those who adhere to miasma theory, suggesting that psychological distress exacerbates physical symptoms, creating a feedback loop that worsens overall health.”
Heidaripor, N., Saeedinezhad, F., & Keykha, A. (2019) · Medical - Surgical Nursing Journal · doi:10.5812/msnj.98348 · Cited by 1
“According to several studies, self-care behaviors of patients with COPD are lower than desired (8-11).”
BackgroundOláh, M., Kresznerits, S., Kun, C., Perczel-Forintos, D., Csánky, E., & Mészáros, Á. (2020) · Orvosi Hetilap · doi:10.1556/650.2020.31617 · Cited by 1
A supportive framework for the care of older adults with COPD
Kuntz, A. A., & Holden, T. R. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17330 · Cited by 1
“Appropriate supportive care may begin with optimization of inhaled therapies, according to GOLD guidelines, as up to 30% of patients with COPD may be over or undertreated when compared to guidelines, and as many of 50% of patients may not be adherent with inhaled prescriptions.(28,29) The inhaler technique is also imp…”
MethodAdherence to inhaled medication in COPD : predictors and outcomes
Huurne, K. K.-T. (2018) · doi:10.3990/1.9789036545440
Lu, H., Ma, Y., Zeng, H., Zeng, Y., Chen, P., & Chen, Y. (2022) · Research Square · doi:10.21203/rs.3.rs-1223439/v1
Liistro, G., de Macedo, J. R. F. F., Pieters, T., Caty, G. D., & Reychler, G. (2022) · Fisioterapia Brasil · doi:10.33233/fb.v22i6.4953
“Despite these important benefits, many patients do not follow the program [7,9, 13-17].”
BackgroundThe acupuncture-related therapy for stable chronic obstructive pulmonary disease
Li, Z., Lou, J., Wang, C., & Zhang, H. (2022) · Medicine · doi:10.1097/md.0000000000028832
“There are some special organizations that can provide help to supervise, but it costs higher medical expenses.([10,11]) Therefore, seeking other effective treatments for stable COPD to improve the efficacy and patient adherence as well as cut down the cost remains a challenging clinical problem.”
BackgroundArticle, R. H., Gouva, M., Mazetas, D., Gouva, M., Economou, A., Gerogianni, I., & Gourgou, K. I. (2023) · International Journal of Psychiatry · doi:10.33140/ijp.08.05.03
“However, this goal requires a change of perception of a patient’s role in their own healthcare and the long-term commitment of the patient to the suggested treatment, a premise that is not usually observed [10].”
BackgroundAlmira, S., Pratama, V., Yunus, M. R., Rozaliyani, A., & Sauriasari, R. (2023) · Jurnal Respirologi Indonesia · doi:10.36497/jri.v43i4.479
“28 Of the three articles, two used the Morisky Scale method, while another used medication refill adherence.”
MethodMedication use of Canadians with chronic obstructive pulmonary disease: a cohort study
Stickland, M. K., Martins, K. J. B., Sharpe, H. M., Vu, K. N., Bhutani, M., Walker, B., Williamson, T. S., Bohlouli, S., Richer, L. P., & Klarenbach, S. W. (2023) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2023-002083
Reda, V., & Fabbo, A. (2023) · Noninvasive ventilation. The essentials · doi:10.1007/978-3-031-37796-9_34
Bahoor, S., & Ziaeirad, M. (2024) · Journal of Health and Care · doi:10.61186/jhc.26.2.196
Kim, H., Kim, H. B., Yoon, Y., & Hong, S. H. (2025) · Healthcare · doi:10.3390/healthcare13121431
“Additionally, pharmacotherapy characteristics, such as the prescriber practice setting, polypharmacy, medication treatment duration, and inhaler type, contribute to adherence behaviors [2,16,17].”
Jaiswal, T., Gupta, S., Anand, P., Ish, P., Sakkarwal, D., & Sahu, D. (2025) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2025.3498
Ammous, O., Andreas, S., Friede, T., Kampo, R. S., Schwarz, S. B., Wollsching-Strobel, M., Salem, S., Windisch, W., & Mathes, T. (2023) · Figshare · doi:10.6084/m9.figshare.24113009
Ammous, O., Andreas, S., Friede, T., Kampo, R. S., Schwarz, S. B., Wollsching-Strobel, M., Salem, S., Windisch, W., & Mathes, T. (2023) · Figshare · doi:10.6084/m9.figshare.24113006
Cuperus, L. J. A., van der Palen, J., Aldenkamp, A. F., van Huisstede, A., Bischoff, E. W. M. A., van Boven, J. F. M., Brijker, F., Dik, S., van Excel, J. A. J. M., Goosens, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26182256
Ammous, O., Andreas, S., Friede, T., Kampo, R. S., Schwarz, S. B., Wollsching-Strobel, M., Salem, S., Windisch, W., & Mathes, T. (2023) · Figshare · doi:10.6084/m9.figshare.24113003
Kosmas, E., Bartziokas, Κ., Loukides, S., Bakakos, P., Rovina, N., Georgatou, N., Papapetrou, D., Katerelos, P., Papapostolou, E., Efstathopoulos, P., et al. (2026) · Respiratory Medicine · doi:10.1016/j.rmed.2026.108682
Huang, P., Huang, H., Chen, W., Zeng, Q., Lin, X., Dong, H., He, W., & Lin, Y. (2026) · Western Journal of Nursing Research · doi:10.1177/01939459261416343
“33,34 The positive association between longer treatment duration and better adherence in C3 contrasts with some studies that report adherence declining over time.”
Liu, H., Fukasawa, T., Miyamoto, A., Hirai, K., Watanabe, T., Asai, K., Akaike, T., Yoshida, S., & Kawakami, K. (2026) · Respiratory Investigation · doi:10.1016/j.resinv.2026.101408
Ogata, H., Tsubouchi, K., Takano, T., Maeda, M., Oda, F., Okamoto, I., & Fukuda, H. (2026) · Respiratory Research · doi:10.1186/s12931-026-03658-7
“Adequate medication adherence and treatment persistence are essential for achieving optimal clinical outcomes [1, 5–7], with poor adherence having been associated with an increased risk of exacerbations, hospitalizations, and mortality as well as greater health care utilization and an increased…”
Liu, H., Fukasawa, T., Miyamoto, A., Hirai, K., Watanabe, T., Asai, K., Akaike, T., Yoshida, S., & Kawakami, K. (2026) · Respiratory Investigation · doi:10.1016/j.resinv.2026.101448
Harlander, M., Subic, T., Eržen, R., Cafuta, A. M., Lopert, A., Horvat, A., Božič, D., Klobučar, A., Krstić, Z., Todorović, N., et al. (2026) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412555.2026.2681198
Metadata
- Authors
- Rogliani, P., Ora, J., Puxeddu, E., Matera, M. G., & Cazzola, M.
- Affiliations
- University of Rome Tor Vergata (IT)
- Policlinico Tor Vergata (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Cazzola, Mario
- Venue
- Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 129
- Pages
- 117-123
- ISSN
- 0954-6111 (ISSN-L)
- OpenAlex
- W2624975405
- Cited by
- 102
- References
- 46
- Citations by year
- 2026: 9 · 2025: 4 · 2024: 16 · 2023: 20 · 2022: 11 · 2021: 14 · 2020: 12 · 2019: 7 · 2018: 5 · 2017: 4
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
- Keywords
- chronic obstructive pulmonary disease, medication adherence, non-compliance, pharmacotherapy, patient beliefs, polypharmacy, social support, access to medicines
- MeSH terms
- Assessment of Medication Adherence, Administration, Inhalation, Adrenal Cortex Hormones, Adrenergic beta-Agonists, Classification, Communication, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Pharmacists, Physicians, Social Support, Survival Analysis, Drug Monitoring, Pulmonary Disease, Chronic Obstructive, Medication Adherence, Self Report
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