Abstract
BackgroundComorbidities and adherence to inhaled therapy appears to have a major impact on treatment goals, health status and disease control in chronic obstructive pulmonary disease (COPD). Aim of the study was to assess levels of adherence to inhalers, comorbidities and associations with COPD outcomes in patients residing in rural and semi-urban areas of Greece.MethodsTwo hundred fifty-seven COPD patients were enrolled from primary health care in 2015–2016. Physicians used structured interviews and questionnaires to assess quality of life and disease status. Patients were classified into groups according to GOLD 2019 guidelines (based on CAT and mMRC). Adherence to inhalers was measured with the Test of Adherence to Inhalers (TAI). Multivariate linear and logistics regression models were used to assess associations between comorbidities and adherence to inhalers with COPD outcomes, including CAT and mMRC scores, exacerbations and GOLD A-D status.Results74.1% of COPD patients reported poor adherence, while most of them were characterized as deliberate non-compliers (69.5%). 77.1% had ≥2 comorbidities, with overweight/obese (82.2%), hypertension (72.9%) and diabetes mellitus (58%) being the most prevalent. In multivariate analysis, COPD outcomes having significant associations with poor adherence included worse health status [OR (95% CI) 4.86 (1.61–14.69) and 2.93 (1.51–5.71) based on CAT and mMRC, respectively], having ≥2 exacerbations in the past year [4.68 (1.51–4.44)], and disease status e.g., be in groups C or D [3.13 (1.49–8.53) and 3.35 (1.24–9.09) based on CAT and mMRC, respectively). Subjects with gastroesophageal reflux showed better inhaler adherence [OR (95% CI) 0.17 (0.6–0.45)], but none of the comorbid conditions was associated with COPD outcomes after adjustments.ConclusionsPoor adherence to inhalers and comorbidities are both prevalent in COPD patients of primary care residing in rural/semi-urban areas of Greece, with adherence influencing COPD outcomes. Raising awareness of patients and physicians on the importance of comorbidities control and inhaler adherence may lead to interventions and improve outcomes.
Highlights
Comorbidities and adherence to inhaled therapy appears to have a major impact on treatment goals, health status and disease control in chronic obstructive pulmonary disease (COPD)
According to COPD Assessment Test (CAT) (≥10) and Modified Medical Research Council Dyspnea Scale (mMRC) (≥2) tools, uncontrolled symptoms/poor health status was found in 224 (91.1%) and 154 (60.6%), respectively. ≥2 exacerbations were seen in 77 (37.2%) subjects, with Global Initiative for Chronic Obstructive Lung Disease (GOLD) group B being the largest followed by groups D, A and C
One hundred and eightynine (77.1%) COPD patients suffered from ≥2 comorbidities, but when overweight/obese was excluded from the comorbidity sum score this number dropped to 108 (42.5%) subjects
Summary
Comorbidities and adherence to inhaled therapy appears to have a major impact on treatment goals, health status and disease control in chronic obstructive pulmonary disease (COPD). Aim of the study was to assess levels of adherence to inhalers, comorbidities and associations with COPD outcomes in patients residing in rural and semi-urban areas of Greece. Chronic obstructive pulmonary disease (COPD) is a challenging public health problem [1, 2] and relatively under-diagnosed in many rural and semi-urban regions worldwide [3,4,5]. Adherence to inhalers in COPD patients is found to be relatively poor with non-adherence rates ranging between 50 and 80% [11,12,13,14]. In Greece, a nationwide COPD study showed that moderate to poor adherence approximated 50% [16] and in another study patient-reported non-adherence led to 11.5% more exacerbations and 14.1% more hospitalizations per year [16], with economic impact as well [17]
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