Cited by 490Medication Adherence and ComplianceChronic Obstructive Pulmonary Disease (COPD) ResearchPharmacy and Medical Practices

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Patient adherence in COPD

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Bourbeau, J, Bartlett, S J·2008·Thorax

DOI 10.1136/thx.2007.086041PMC PMC4747423

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Abstract

Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients' perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients' beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients.

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Background
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Background
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Background
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Background
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BackgroundInfluential
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“of bronchodilators; rapid relief from symptoms provides reassurance of effect and may help improve compliance with the medication (Breekveldt-Postma et al., 2007; Bourbeau and Bartlett, 2008).”
Background
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“regimen of indacaterol, combined with clinically relevant bronchodilation at 5 min post-dose may contribute to improved adherence to the prescribed dose regimen in the ‘real world’ setting—an important consideration, because adherence to COPD medication in clinical practice are reported to be between 10 and 40% [19-21…”
Background
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Background
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“Previous reports have endorsed the strategies employed in our study to improve medication adherence, namely (1) continuous monitoring of care (2) explaining the rationale for prescription (3) providing information in both written and verbal forms about disease and drug regimens, (4) assessment of medication adherence…”
BackgroundMethod
Indacaterol once-daily provides superior efficacy to salmeterol twice-daily in COPD: A 12-week study
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Background
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“One study documented that nine out of 10 patients did not use their inhaler correctly,((6)) which impacted adherence((26)) and led to the suboptimal management of COPD.”
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“The lack of adherence to a therapeutic strategy is a significant obstacle in optimal management of COPD and results in increased rates of morbidity, healthcare expenditure, and hospitalisation, as well as increased risk of mortality, unnecessary escalation of therapy and poorer quality of life [64].”
Background
A blinded evaluation of the efficacy and safety of glycopyrronium, a once-daily long-acting muscarinic antagonist, versus tiotropium, in patients with COPD: the GLOW5 study
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“Additionally, a faster onset of action is desirable, as longterm adherence to therapy may be lower for medications that do not have an immediate or direct effect on COPD symptoms [22].”
Background
Adherence to Long-Acting Inhaled Therapies among Patients with Chronic Obstructive Pulmonary Disease (COPD)
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“, the clinician-patient relationship) and the complexity and eff ectiveness of current medications (8, 9).”
Background
Drug–Target Association Kinetics in Drug Discovery
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“The challenges of long-term adherence to exercise in COPD are not addressed.(37) In absence of reliable published data, and due to the two-year follow-up during which interruptions were expected, we did not have any a priori definition of completion rate.”
Background
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Influential
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“, increased rates of morbidity, hospitalizations, health care costs, reduced quality of life) (Bourbeau and Bartlett, 2008; Bishay and Sawicki, 2016).”
Background
System Immersion in Virtual Reality-Based Rehabilitation of Motor Function in Older Adults: A Systematic Review and Meta-Analysis
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Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations
van Boven, J. F. M., Ryan, D. P., Eakin, M. N., Canonica, G. W., Barot, A., & Foster, J. M. (2016) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2016.03.007 · Cited by 81
“Adherence—a term that comprises (1) initiation of prescribed therapy; (2) implementation of therapy as prescribed (correct dose, inhalation technique, and frequency); and (3) persistence (obtaining refills to maintain adherence over time)—can be affected by many factors,(2) including patient and societal determinants.…”
Background
AIR: Advances in Respiration – Music therapy in the treatment of chronic pulmonary disease
Canga, B., Azoulay, R., Raskin, J. M., & Loewy, J. V. (2015) · Respiratory Medicine · doi:10.1016/j.rmed.2015.10.001 · Cited by 75
Qualitative assessment of attributes and ease of use of the ELLIPTA™ dry powder inhaler for delivery of maintenance therapy for asthma and COPD
Svedsäter, H., Dale, P., Garrill, K., Walker, R. W., & Woepse, M. W. (2013) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-13-72 · Cited by 77
“By simplifying the dosing schedule, a shift from twice-daily to once-daily treatment may have a beneficial effect on treatment adherence [13,14].”
Background
The Respimat® Soft Mist Inhaler: Implications of Drug Delivery Characteristics for Patients
Iwanaga, T., Tohda, Y., Nakamura, S., & Suga, Y. (2019) · Clinical Drug Investigation · doi:10.1007/s40261-019-00835-z · Cited by 77
Controversies in treatment of chronic obstructive pulmonary disease
Rabe, K. F., & Wedzicha, J. A. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61295-6 · Cited by 75
Barriers and Strategies for Improving Medication Adherence Among People Living With COPD: A Systematic Review
Bhattarai, B., Walpola, R. L., Mey, A., Anoopkumar‐Dukie, S., & Khan, S. A. (2020) · Respiratory Care · doi:10.4187/respcare.07355 · Cited by 79
“This review supports the finding of a previous review that depression results in lower health status and is connected with reduced adherence among subjects with COPD.(80) Cognitive function in subjects with COPD could be affected by depressive and anxiety symptoms, which may, in due course, affect treatment adherence.”
Influential
Relationship Between Medication Adherence and Health-Related Quality of Life in Subjects With COPD: A Systematic Review
Ágh, T., Dömötör, P., Bártfai, Z., Inotai, A., Fujsz, E., & Mészáros, Á. (2014) · Respiratory Care · doi:10.4187/respcare.03123 · Cited by 74
“The following information was extracted from each study: (1) the first author and year of publication, (2) the country, (3) the study design, (4) the study population characteristics (size, percent male, mean age, percent-of-predicted FEV1, COPD stage), (5) the medication therapy, (6) the method of measuring and defin…”
BackgroundMethod
Determinants of polypharmacy and compliance with GOLD guidelines in patients with chronic obstructive pulmonary disease
Franssen, F. M. E., Spruit, M. A., & Wouters, E. F. �. (2011) · International Journal of COPD · doi:10.2147/copd.s24443 · Cited by 73
“Furthermore, polypharmacy and prescription of multiple daily doses contribute to poor patient adherence in COPD, which is a significant concern.(16) Although higher age, female gender, and the presence of multiple comorbidities are some of the factors correlated with polypharmacy in the elderly,(17) determinants of po…”
Buddy biking: a user study on social collaboration in a virtual reality exergame for rehabilitation
Høeg, E. R., Bruun‐Pedersen, J. R., Cheary, S., Andersen, L. K., Paisa, R., Serafin, S., & Lange, B. S. (2021) · Virtual Reality · doi:10.1007/s10055-021-00544-z · Cited by 71
The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support
Dew, M. A., DiMartini, A. F., Dobbels, F., Grady, K. L., Jowsey‐Gregoire, S. G., Kaan, A., Kendall, K., Young, Q., Abbey, S. E., Butt, Z. A., et al. (2018) · Psychosomatics · doi:10.1016/j.psym.2018.04.003 · Cited by 64
Exploring the barriers and facilitators for the use of digital health technologies for the management of COPD: a qualitative study of clinician perceptions
Slevin, P., Kessie, T., Cullen, J., Butler, M. W., Donnelly, S. C., & Caulfield, B. (2019) · QJM · doi:10.1093/qjmed/hcz241 · Cited by 66
A qualitative study of chronic obstructive pulmonary disease patient perceptions of the barriers and facilitators to adopting digital health technology
Slevin, P., Kessie, T., Cullen, J., Butler, M. W., Donnelly, S. C., & Caulfield, B. (2019) · Digital Health · doi:10.1177/2055207619871729 · Cited by 66
Impact of community pharmacists in COPD management: Inhalation technique and medication adherence
Hesso, I., Nabhani‐Gebara, S., & Kayyali, R. (2016) · Respiratory Medicine · doi:10.1016/j.rmed.2016.07.010 · Cited by 61
“Some authors argue for poor IT to be a form of poor adherence [13], whereas others see that poor adherence can be triggered by poor IT, as the latter can result in patient’s dissatisfaction with the treatment [3].”
Background
“I struggle to count my blessings”: recovery after hip fracture from the patients’ perspective
Bruun‐Olsen, V., Bergland, A., & Heiberg, K. E. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0716-4 · Cited by 61
“This reflects the contemporary view of the patients as collaborators in their own recovery process [42].”
Background
Exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers–Danlos syndrome – hypermobility type
Simmonds, J. V., Herbland, A., Hakim, A., Ninis, N., Lever, W., Aziz, Q., & Cairns, M. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2017.1398278 · Cited by 60
“Adherence and concordance with exercise and improved outcomes may be facilitated through the development of a positive therapeutic alliance [50].”
Background
24-hour Bronchodilation following a single dose of the novel β2-agonist olodaterol in COPD
van Noord, J. A., Smeets, J. J., Drenth, B. M., Rascher, J., Pivovarova, A., Hamilton, A., & Cornelissen, P. J. G. (2011) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2011.07.006 · Cited by 60
Helping COPD patients change health behavior in order to improve their quality of life
Almagro, P., & Castro (2013) · International Journal of COPD · doi:10.2147/copd.s34211 · Cited by 60
“Nonadherence is a multidetermined problem caused by, among others factors, the patient–provider relationship, the complexity of the therapy, the immediacy of beneficial effects, and patient education and knowledge of the disease.(103) Inherent in the definition of “compliance” is the idea that patients are passive, ac…”
Profile of glycopyrronium for once-daily treatment of moderate-to-severe COPD
Buhl, R., & Banerji (2012) · International Journal of COPD · doi:10.2147/copd.s36001 · Cited by 58
“Rapid relief from symptoms may provide reassurance of effect and help improve compliance with medication.(9,42) Furthermore, a rapid onset of action has important implications in COPD, as it provides immediate relief from early morning symptoms, which are considered by patients to be the most problematic.”
COPD Management in Primary Care: An Observational, Community Pharmacy–Based Study
Mehuys, E., Boussery, K., Adriaens, E., Bortel, L. M. V., Bolle, L. D., Tongelen, I. V., Remon, J., & Brusselle, G. (2010) · Annals of Pharmacotherapy · doi:10.1345/aph.1m481 · Cited by 58
COPD: understanding patients’ adherence to inhaled medications
Araújo, A., Teixeira, P., Hespanhol, V. P., & de Sousa, J. C. (2018) · International Journal of COPD · doi:10.2147/copd.s160982 · Cited by 58
Spirometry Measurement of Peak Inspiratory Flow Identifies Suboptimal Use of Dry Powder Inhalers in Ambulatory Patients with COPD
Duarte, A. G., Tung, L., Zhang, W., Hsu, E. S., Kuo, Y., & Sharma, G. (2019) · Chronic Obstructive Pulmonary Diseases Journal of the COPD Foundation · doi:10.15326/jcopdf.6.3.2018.0163 · Cited by 59
Efficacy of a multifactorial intervention on therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled trial
Leiva-Fernández, J., Leiva-Fernández, F., García-Ruiz, A., Prados-Torres, D., & Barnestein-Fonseca, P. (2014) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-14-70 · Cited by 57
“The intervention was considered the predictive variable, and the rest of the independent measures that were statistically significant during univariate analysis or that were considered clinically relevant because they were related to adherence in other studies [15,16,34-36] were considered the possible modifying facto…”
Background
Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device
Dekhuijzen, P. N. R., Batsiou, M., Bjermer, L. H., Bosnic-Anticevich, S. Z., Chrystyn, H., Papi, A. A., Rodriguez‐Roisin, R., Fletcher, M. J., Wood, L., Cifra, A., et al. (2016) · Respiratory Medicine · doi:10.1016/j.rmed.2016.09.015 · Cited by 57
A comparison of medication adherence/persistence for asthma and chronic obstructive pulmonary disease in the United Kingdom
Covvey, J. R., Mullen, A. B., Ryan, M. A., Steinke, D. T., Johnston, B. F., Wood, F. T., & Boyter, A. C. (2014) · International Journal of Clinical Practice · doi:10.1111/ijcp.12451 · Cited by 56
Safety of indacaterol in the treatment of patients with COPD
Donohue, J. F., Singh, D., Kornmann, O., Lawrence, Lassen, & Krämer, B. (2011) · International Journal of COPD · doi:10.2147/copd.s23816 · Cited by 54
Nonadherence in chronic obstructive pulmonary disease patients
Bender, B. G. (2014) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0000000000000027 · Cited by 55
“The association between depression and nonadherence in COPD is strong [30], although how depression undermines adherence is not fully understood and no studies have shown that treatment for depression increases adherence.”
Background
Effect on lung function and morning activities of budesonide/formoterol versus salmeterol/fluticasone in patients with COPD
Partridge, M. R., Schuermann, W., Beckman, O., Persson, T., & Polanowski, T. (2009) · Therapeutic Advances in Respiratory Disease · doi:10.1177/1753465809344870 · Cited by 55
“These findings, combined with the knowledge that the speed of symptom relief is central to patients’ treatment expectations and adherence [Bourbeau and Bartlett, 2008; Miravitlles et al. 2007], raises the question of whether a treatment with a rapid onset of effect would lead to improved outcomes in patients with COPD…”
Background
The effects of anxiety and depression symptoms on treatment adherence in COPD patients
Turan, O., Yemez, B., & İtil, O. (2013) · Primary Health Care Research & Development · doi:10.1017/s1463423613000169 · Cited by 54
“The adherence to treatment (especially inhaler therapies) is found to be variable by people with COPD (Bourbeau and Bartlett, 2008).”
Background
Real-life inhaler adherence and technique: Time to get smarter!
Chrystyn, H., Audibert, R., Keller, M., Quaglia, B., Vecellio, L., & Roche, N. (2019) · Respiratory Medicine · doi:10.1016/j.rmed.2019.09.008 · Cited by 56
Behavioral Medicine Approaches to Chronic Obstructive Pulmonary Disease
von Leupoldt, A., Fritzsche, A., Trueba, A. F., Meuret, A. E., & Ritz, T. (2012) · Annals of Behavioral Medicine · doi:10.1007/s12160-012-9348-7 · Cited by 53
Personalized Medication Adherence Management in Asthma and Chronic Obstructive Pulmonary Disease: A Review of Effective Interventions and Development of a Practical Adherence Toolkit
van de Hei, S. J., Dierick, B. J. H., Aarts, J. E. P., Kocks, J. W. H., & van Boven, J. F. M. (2021) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2021.05.025 · Cited by 55
The Disability Burden of COPD
Snider, J. T., Romley, J. A., Wong, K. S., Zhang, J., Eber, M., & Goldman, D. P. (2012) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.3109/15412555.2012.696159 · Cited by 53
A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: The COPE-III study protocol
Lenferink, A., Frith, P. A., van der Valk, P., Buckman, J., Sladek, R., Cafarella, P., van der Palen, J. A. M., & Effing, T. (2013) · Contemporary Clinical Trials · doi:10.1016/j.cct.2013.06.003 · Cited by 55
“An important contributor towards success of treatment is adherence [53], defined as the patient's active role in consenting to and following prescribed treatments [54].”
Background
A comparison of the efficacy and safety of once-daily fluticasone furoate/vilanterol with twice-daily fluticasone propionate/salmeterol in moderate to very severe COPD
Agustí, A. G. N., de Teresa, L., Backer, W. D., Zvarich, M. T., Locantore, N., Barnes, N. C., Bourbeau, J., & Crim, C. C. (2013) · European Respiratory Journal · doi:10.1183/09031936.00054213 · Cited by 52
“This simplified dosing regime may improve adherence [34, 35] and consequently has the potential to provide better disease control and improved outcomes [36].”
BackgroundSelf-citation
Correlates of adherence to respiratory drugs in COPD patients
Laforest, L., Denis, F., Ganse, E. H. V., Ritleng, C., Saussier, C., Passante, N., Devouassoux, G., Chatte, G., Freymond, N., & Pachéco, Y. (2010) · Primary Care Respiratory Journal · doi:10.4104/pcrj.2010.00004 · Cited by 52
“Poly-pharmacy leads to complicated regimens, and confusion about medications is a well-known causative factor of poor adherence in chronic diseases,(21) notably in COPD.(11,15) Similar caution is required in interpreting the absence of impact of the overall number of co-morbid diagnoses.”
BackgroundInfluential
Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression
Albrecht, J. S., Park, Y., Hur, P., Huang, T.-Y., Harris, I., Netzer, G., Lehmann, S. W., LANGENBERG, P. W., Khokhar, B., Wei, Y. J., et al. (2016) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201602-136oc · Cited by 56
“Other studies have not reported a significant association between sex and adherence to COPD medications or medications generally.(11,20,45,48) In our study, women comprised 65% of the study sample, and 75% of those with depression; hence, residual confounding by depression status is Page 13 of 25”
Background
Onset of action of indacaterol in patients with COPD: Comparison with salbutamol and salmeterol-fluticasone
Krämer, B. (2010) · International Journal of COPD · doi:10.2147/copd.s12120 · Cited by 51
“In addition, adherence is lower for medications that do not have an immediate effect on symptoms.(7) Indacaterol is a novel, inhaled once-daily ultra-longacting β 2 -agonist (LABA)(8) for the treatment of COPD.”
Teaching inhaler use in chronic obstructive pulmonary disease patients
Lareau, S. C., & Hodder, R. V. (2011) · Journal of the American Academy of Nurse Practitioners · doi:10.1111/j.1745-7599.2011.00681.x · Cited by 50
“Improper use of inhaler devices can reduce their effectiveness (and therefore control of COPD), and contributes to decreased patient adherence and an increased disease burden for patients, caregivers, and society (Bourbeau & Bartlett, 2008).”
Background
The Impact of Inhaler Device Regimen in Patients with Asthma or COPD
Usmani, O. S., Hickey, A. J., Guranlioglu, D., Rawson, K., Stjepanovic, N., Siddiqui, S. S., & Dhand, R. (2021) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2021.04.024 · Cited by 48
“Therapy adherence is lower for medications that do not have an immediate effect on symptoms; therefore, setting appropriate expectations for medication effects could improve adherence.(56) Different devices should be accessible within each drug class, allowing physicians and patients to select the most appropriate dev…”
Background
Long-acting bronchodilators in COPD: where are we now and where are we going?
Cazzola, M., & Page, C. P. (2014) · Breathe · doi:10.1183/20734735.014813 · Cited by 48
“In addition, adherence is lower for medications that do not have an immediate effect on symptoms [23].”
Background
24-hour bronchodilator efficacy of single doses of indacaterol in subjects with COPD: comparison with placebo and formoterol
Bauwens, O., Ninane, V., de Maele, B. V., Firth, R., Dong, F., Owen, R. J., & Higgins, M. (2008) · Current Medical Research and Opinion · doi:10.1185/03007990802675096 · Cited by 46
Symptom burden and self-management in persons with chronic obstructive pulmonary disease
Bringsvor, H. B., Skaug, K., Langeland, E., Oftedal, B. F., Aßmus, J., Gundersen, D., Osborne, R. H., & Bentsen, S. B. (2018) · International Journal of COPD · doi:10.2147/copd.s151428 · Cited by 46
“Previously, self-management emphasized that patients follow directions given by health care professionals and meet expectations for compliance with prescribed therapies and medical treatment.(8) Recent research has indicated that selfmanagement is a multidimensional construct that consists of various domains.”
Impact of adherence to treatment with tiotropium and fluticasone propionate/salmeterol in chronic obstructive pulmonary diseases patients
Ismaila, A., Corriveau, D., Vaillancourt, J., Parsons, D., Dalal, A., Su, Z. Z., & Sampalis, J. S. (2014) · Current Medical Research and Opinion · doi:10.1185/03007995.2014.908828 · Cited by 45
The MABA approach: a new option to improve bronchodilator therapy
Cazzola, M., López-Campos, J. L., & Puente‐Maestu, L. (2013) · European Respiratory Journal · doi:10.1183/09031936.00067013 · Cited by 45
Predictors of adherence to treatment in bronchiectasis
McCullough, A. R., Tunney, M. M., Elborn, J. S., Bradley, J. M., & Hughes, C. M. (2015) · Respiratory Medicine · doi:10.1016/j.rmed.2015.04.011 · Cited by 42

Authors: Bourbeau, J., & Bartlett, S. J.
Affiliations: McGill University Health Centre (CA)
Johns Hopkins University (US)
Corresponding author: Bourbeau, J
ORCID: Bourbeau, J
Bartlett, S J
Venue: Thorax
Publisher: BMJ
Published: 2008-09-01
Volume: 63
Issue: 9
Pages: 831-838
ISSN: 0040-6376 (ISSN-L)
DOI: 10.1136/thx.2007.086041
PMC: PMC4747423
OpenAlex: W2138833643
Cited by: 490
References: 101
Citations by year: 2026: 9 · 2025: 16 · 2024: 25 · 2023: 22 · 2022: 24 · 2021: 32 · 2020: 30 · 2019: 24 · 2018: 42 · 2017: 34 · 2016: 37 · 2015: 23 · 2014: 37 · 2013: 41 · 2012: 24
FWCI: 2.80
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Thorax (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
HighWire Press Open Archive (submittedVersion)
Funders: McGill University
National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR051351)
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, patient-provider communication, self-management, polypharmacy, complex medication regimens, smoking, health care utilization, quality of life
MeSH terms: Attitude to Health, Communication, Humans, Patient Compliance, Perception, Professional-Patient Relations, Caregivers, Polypharmacy, Pulmonary Disease, Chronic Obstructive

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