Abstract
BackgroundPoor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs. This study aimed to investigate the impact of an acoustic reminder and support calls on adherence to inhaled therapy in asthma and COPD patients and to determine their effect on exacerbations.MethodsThis single-blinded randomized controlled trial investigated asthma and COPD patients during 6 months in an ambulatory setting. The intervention consisted of daily alarm clock and support phone calls, whenever use of rescue medication doubled or inhaled medication was not taken as prescribed. Primary outcome was time to next exacerbation. Frequency of exacerbations, adherence to inhaled medication and quality of life scores were secondary outcomes. Cox and Poisson regression were used to determine intervention effect on time to exacerbation and frequency of exacerbations, respectively.ResultsSeventy-five participants were assigned to the intervention group and 74 to usual follow-up care. During a median follow-up of 6.2 months, 22 and 28% in the intervention and control groups respectively, experienced at least one exacerbation. Intervention had no effect on time to first exacerbation (HR 0.65, 95% CI 0.21 to 2.07, P = .24), but showed a trend toward a 39% decreased frequency of exacerbations (RR = 0.61, 95% CI 0.35 to 1.03, P = .070) for the adjusted models, respectively. The intervention group had significantly more days with 80–100% taking adherence regarding puff inhalers (82 ± 14% vs. 60 ± 30%, P < .001) and dry powder capsules (90 ± .10% vs. 80 ± 21%, P = .01). Timing adherence in participants using puff inhalers was higher in the intervention group (69 ± 25% vs. 51 ± 33%, P < .001). No significant differences in QoL were found between the two groups.ConclusionParticipants assigned to the intervention group had significantly better taking and timing adherence of inhaled medication resulting in a trend towards a decreased frequency of exacerbations. However, no effect on time to next exacerbation was observed.Trial registrationClinicalTrials.gov: NCT02386722, Registered 14 February 2014.
Highlights
Poor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs
169 adult participants with an established asthma-diagnosis according to the Global Initiative for Asthma (GINA) guidelines [22] and/ or an established chronic obstructive pulmonary disease (COPD) diagnosis according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Depending on the prescribed medication, all participants were equipped with Smartinhaler devices for puff inhalers such as metered dose inhalers and multidose dry powder inhalers (Adherium Ltd., Auckback, New Zealand) and/or with Electronic Monitoring System (POEMS) consisting of a printed, selfadhesive polymer film affixed to a multidose punch card (Pharmis GmbH, Beinwil am See, Switzerland) that had been prefilled with dry powder capsules
Summary
Poor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs. This study aimed to investigate the impact of an acoustic reminder and support calls on adherence to inhaled therapy in asthma and COPD patients and to determine their effect on exacerbations. Poor adherence to prescribed medication is common in patients with asthma and COPD, varying from < 23–70% [2,3,4,5]. Suboptimal or non-adherence to inhaled therapies has been shown to be associated with increased rates of morbidity, healthcare expenditures, hospitalisations, and mortality [7, 8]. Exacerbations adversely affect patients’ quality of life, lung function, and mortality [12]. It is noteworthy that higher adherence rates have been associated with lower exacerbation rates in patients with asthma [15, 16] and COPD [17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
