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Objective Assessment of Adherence to Inhalers by COPD Patients.

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posted on 22.11.2019, 15:42 by Imran Sulaiman, Breda Cushen, Garrett Greene, Jansen Seheult, Dexter Seow, Fiona Rawat, Elaine MacHale, Matshediso Mokoka, Catherine Nora Moran, Aoife Sartini Bhreathnach, Philippa MacHale, Shahed Tappuni, Brenda Deering, Mandy Jackson, Hannah McCarthy, Lisa Mellon, Frank Doyle, Fiona Boland, Richard B. Reilly, Richard W. Costello

RATIONALE: Objective adherence to inhaled therapy by patients with COPD has not been reported.

OBJECTIVES: The aim of this study was to objectively quantify adherence to preventer DiskusTM inhaler therapy by patients with COPD with an electronic audio recording device (INCATM).

METHODS: This was a prospective observational study. On discharge from hospital patients were given a salmeterol/fluticasone inhaler with an INCATM device attached. Analysis of this audio quantified the frequency and proficiency of inhaler use.

MEASUREMENTS AND MAIN RESULTS: COPD patients (n=265) were recruited. The mean age 71 years, mean Forced Expiratory Volume in 1-second 1.3 Litres, and 80% had evidence of mild/moderate cognitive impairment. By combining time of use, interval between doses and critical technique errors, thus incorporating both intentional and unintentional non-adherence, a measure "Actual Adherence" was calculated. Mean Actual Adherence was 22.9% of that expected if the doses were taken correctly and on time. Seven percent had an Actual Adherence>80%. Hierarchical clustering found three equally sized well-separated clusters corresponding to distinct patterns: Cluster 1 (34%) had low inhaler use and high error rates, Cluster 2 (31%) had high inhaler use and high error rates, and Cluster 3 (30%) had overall good adherence. Lung function and co-morbidities were predictive of poor technique, while age and cognition with poor lung function distinguished those with poor adherence and frequent errors in technique.

CONCLUSION: These data may inform clinicians both in understanding why a prescribed inhaler is not effective and to devise strategies to promote adherence in COPD.

Funding

Health Research Board of Ireland.

History

Comments

Originally Published in: Sulaiman I, Cushen B, Greene G, Seheult J, Seow D, Rawat F, MacHale E, Mokoka M, Moran CN, Sartini Bhreathnach A, MacHale P, Tappuni S, Deering B, Jackson M, McCarthy H, Mellon L, Doyle F, Boland F, Reilly RB1, Costello RW. Objective Assessment of Adherence to Inhalers by COPD Patients. American Journal of Respiratory and Critical Care Medicine. 2016;195(10):1333-1343. DOI: 10.1164/rccm.201604-0733OC. Copyright © 2015 by the American Thoracic Society The final publication is available at http://www.atsjournals.org/doi/abs/10.1164/rccm.201604-0733OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed#.V9k5kvmU1QI

Published Citation

Sulaiman I, Cushen B, Greene G, Seheult J, Seow D, Rawat F, MacHale E, Mokoka M, Moran CN, Sartini Bhreathnach A, MacHale P, Tappuni S, Deering B, Jackson M, McCarthy H, Mellon L, Doyle F, Boland F, Reilly RB, Costello RW. Objective Assessment of Adherence to Inhalers by COPD Patients. American Journal of Respiratory and Critical Care Medicine. 2016;195(10):1333-1343.

Publication Date

13/07/2016

Publisher

American Thoracic Society

PubMed ID

27409253

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