Cited by 516Chronic Obstructive Pulmonary Disease (COPD) ResearchMedication Adherence and ComplianceInhalation and Respiratory Drug Delivery

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Adherence to inhaled therapy, mortality and hospital admission in COPD

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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·2009·Thorax

DOI 10.1136/thx.2009.113662

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Abstract

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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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
ORCID: Vestbo, J
Anderson, J A
Calverley, P M A
Celli, B
Ferguson, G T
Jenkins, C
Yates, J C
Jones, P W
Venue: Thorax
Publisher: BMJ
Published: 2009-08-23
Volume: 64
Issue: 11
Pages: 939-943
ISSN: 0040-6376 (ISSN-L)
DOI: 10.1136/thx.2009.113662
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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