Adherence to inhaled therapy, mortality and hospital admission in COPD
Open accessAbstract
BACKGROUND: Little is known about adherence to inhaled medication in chronic obstructive pulmonary disease (COPD) and the impact on mortality and morbidity. METHODS: Data on drug adherence from a randomised double-blind trial comparing inhaled salmeterol 50 microg + fluticasone propionate 500 microg twice daily with placebo and each drug individually in 6112 patients with moderate to severe COPD over 3 years in the TORCH study were used. All-cause mortality and exacerbations leading to hospital admission were primary and secondary end points. The study of adherence was not specified a priori as an ancillary study. RESULTS: Of the 4880 patients (79.8%) with good adherence defined as >80% use of study medication, 11.3% died compared with 26.4% of the 1232 patients (20.2%) with poor adherence. The annual rates of hospital admission for exacerbations were 0.15 and 0.27, respectively. The association between adherence and mortality remained unchanged and statistically significant after adjusting for other factors related to prognosis (hazard ratio 0.40 (95% CI 0.35 to 0.46), p<0.001). The association was even stronger when analysing on-treatment deaths only. Similarly, the association between adherence and hospital admission remained unchanged and significant in a multivariate analysis (rate ratio 0.58 (95% CI 0.44 to 0.73, p<0.001). The association between increased adherence and improved mortality and reduction in hospital admission was independent of study treatment. The effect of treatment was more pronounced in patients with good adherence than in those with poor adherence. CONCLUSION: Adherence to inhaled medication is significantly associated with reduced risk of death and admission to hospital due to exacerbations in COPD. Further research is needed to understand these strong associations.
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Nonadherence to medication is a risk factor for COPD-related hospital admissions.
“There are several risk factors for COPD-related hospital admissions, including nonadherence to medication [5].”
From Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial (2018) · cites this paper as [5]
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Helping COPD patients change health behavior in order to improve their quality of life
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How to Choose the Right Inhaler Using a Patient-Centric Approach?
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Predictors of Adherence to Inhaled Medications Among Veterans with COPD
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Nonadherence in chronic obstructive pulmonary disease patients
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Adherence to COPD treatment in Turkey and Saudi Arabia: Results of the ADCARE study
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“Data from the TORCH study reports no association between adherence to treatment and symptom severity as defined by Global Initiative for Obstructive Lung Disease (GOLD) stage, although patients with poor adherence did have lower baseline FEV 1 and increased dyspnea.(42) Similar findings were reported by another study…”
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Real-life inhaler adherence and technique: Time to get smarter!
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Behavioral Medicine Approaches to Chronic Obstructive Pulmonary Disease
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Chronic obstructive pulmonary disease (COPD) and old age?
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Clinical and economic outcomes of multiple versus single long-acting inhalers in COPD
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Inhaler Adherence in COPD: A Crucial Step Towards the Correct
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Building toolkits for COPD exacerbations: lessons from the past and present
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The Effect Of Veterans Health Administration Coverage On Cost-Related Medication Nonadherence
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Efficacy and safety of CHF6001, a novel inhaled PDE4 inhibitor in COPD: the PIONEER study
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Nurses’ Knowledge of Inhaler Technique in the Inpatient Hospital Setting
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Adherence to controller therapy for chronic obstructive pulmonary disease: a review
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Advances in Audio-Based Systems to Monitor Patient Adherence and Inhaler Drug Delivery
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- Authors
- Vestbo, J., Anderson, J. A., Calverley, P. M. A., Celli, B., Ferguson, G. T., Jenkins, C., Knobil, K., Willits, L. R., Yates, J. C., & Jones, P. W.
- Affiliations
- University of Manchester (GB)
- GlaxoSmithKline (United Kingdom) (GB)
- Aintree University Hospital (GB)
- Tufts University (US)
- Woolcock Institute of Medical Research (AU)
- GlaxoSmithKline (United States) (US)
- St George's, University of London (GB)
- Corresponding author
- Vestbo, J
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2009-08-23
- Volume
- 64
- Issue
- 11
- Pages
- 939-943
- ISSN
- 0040-6376 (ISSN-L)
- OpenAlex
- W2095666112
- Cited by
- 516
- References
- 32
- Citations by year
- 2026: 17 · 2025: 22 · 2024: 36 · 2023: 35 · 2022: 30 · 2021: 34 · 2020: 45 · 2019: 36 · 2018: 33 · 2017: 32 · 2016: 31 · 2015: 35 · 2014: 45 · 2013: 31 · 2012: 17
- FWCI
- 15.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Inhalation and Respiratory Drug Delivery
- Keywords
- chronic obstructive pulmonary disease, medication adherence, inhalation therapy, salmeterol, fluticasone propionate, all-cause mortality, hospitalization, COPD exacerbations, TORCH trial
- MeSH terms
- Fluticasone, Salmeterol Xinafoate, Administration, Inhalation, Adult, Aged, Aged, 80 and over, Albuterol, Androstadienes, Bronchodilator Agents, Drug Administration Schedule, Drug Combinations, Drug Therapy, Combination, Epidemiologic Methods, Female, Hospitalization, Humans, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Medication Adherence
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