Does a Tailored Intervention to Promote Adherence in Patients with Chronic Lung Disease Affect Exacerbations?

Abstract

Background: Poor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs. Objective: 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. Methods: This single-blinded randomized trial investigated patients during 6 months. Exacerbations were recorded and adherence to inhaled medication was monitored using electronic data capture devices. Cox and Poisson regression were used to determine intervention effect on time to exacerbation and frequency of exacerbations, respectively. Results: Of 149 eligible patients, 75 participants were assigned to the intervention group and 74 to usual follow-up care. During follow-up, 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 0.62, 95% CI 0.20 to 1.91, p=.20), but showed a trend toward a 39% decreased frequency of exacerbations (RR=0.61, 95% CI 0.35 to 1.03, p=.070). The intervention group had significantly more days with 80-100% taking adherence regarding puff inhalers (82±14% vs. 60±30%, p Conclusion: Patients in 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.