Objective: It is obvious that adherence to inhaler treatments is insufficient in patients with obstructive lung diseases. In this study, we aimed to evaluate the consistency of the information provided by patients with obstructive pulmonary disease and their households on medication adherence. Material and Methods: A cross-sectional study was conducted between January and March 2020 in a tertiary chest diseases hospital, where patients with asthma and chronic obstructive pulmonary disease (COPD) were regularly followed up. The study included patients who had been followed up with a diagnosis of asthma or COPD for at least 1 year, were using maintenance inhaler therapy, and attended the follow-up visit with a member of the same household. Patients and their household members were independently questioned about patients' medication adherence. According to the information provided by the patients and their households, medication adherence of the patients and the consistency of the information were evaluated. Results: Of the 66 patients with obstructive lung disease, 59 (89.39%) were adherent and 7 (10.60%) were non-adherent according to their own statements. Seventeen (28.81%) of 59 patients who were adherent according to their own statements were non-adherent to treatment with respect to household members. The mean age, gender distribution, smoking status, diagnosis of asthma or COPD, and education level did not differ significantly between self-reported adherent and non-adherent patients or between adherent and non-adherent patients with respect to household members. Conclusion: Adding information from household members to the use of patient self-reports may increase the clinician's judgment in monitoring adherence.
Keywords: Asthma; chronic obstructive pulmonary disease; inhaler therapy; medication adherence; household members
Amaç: Obstrüktif akciğer hastalığında, inhaler tedavilere gösterilen tedavi uyumunun yetersiz olduğu aşikârdır. Bu çalışmada, obstrüktif akciğer hastalığı olan hastalar ve hastaların aynı evi paylaştığı yakınlarının ilaç uyumu konusunda verdikleri bilgilerin tutarlılığını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Ocak-Mart 2020 tarihleri arasında astım ve kronik obstrüktif akciğer hastalığı (KOAH) olanların düzenli olarak takip edildiği bir 3. basamak göğüs hastalıkları hastanesinde kesitsel çalışma yapılmıştır. Çalışmaya, en az 1 yıldır astım veya KOAH tanısı ile takip edilen, idame inhaler tedavisi alan ve aynı haneden bir kişi ile takip ziyaretine katılan hastalar dâhil edildi. İnhaler tedavisi kullanan hastalar ve hastalar ile aynı evi paylaşan aile üyeleri, hastaların ilaç uyumu konusunda bağımsız olarak sorgulandı. Hasta ve ailelerinin verdiği bilgilere göre hastaların ilaç uyumları ve bilgilerin tutarlılığı değerlendirildi. Bulgular: Obstrüktif akciğer hastalığı olan 66 hastanın kendi ifadelerine göre 59'u (%89,39) uyumlu, 7'si (%10,60) uyumsuzdu. Kendi ifadelerine göre uyumlu olan 59 hastanın 17'si (%28,81), hane halkının ifadelerine göre tedaviye uyumsuzdu. Ortalama yaş, cinsiyet dağılımı, sigara içme durumu, astım veya KOAH tanısı ve eğitim düzeyi, hem hastaların kendi beyanlarına göre değerlendirilen uyumlu ve uyumsuz hastalar arasında hem de hane üyelerinin beyanlarına göre değerlendirilen uyumlu ve uyumsuz hastalar arasında anlamlı farklılık göstermedi. Sonuç: Hasta öz bildirimlerine hane halkı üyelerinden bilgi eklemek, klinisyenin tedavi uyumunu izleme konusundaki yargısını artırabilir.
Anahtar Kelimeler: Astım; kronik obstrüktif akciğer hastalığı; inhaler tedavi; ilaç uyumu; hane halkı üyeleri
- Global Strategy for Asthma [Internet]. Copyright © 2020 [Cited: August 25, 2020]. Global Strategy for Asthma Management and Prevention, 2020. Available from: [Link]
- Global Initiative for Chronic Obstructive Lung Disease [Internet]. Copyright © 2020 [Cited: August 25, 2020]. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, 2020. Available from: [Link]
- Gamble J, Stevenson M, McClean E, Heaney LG. The prevalence of nonadherence in difficult asthma. Am J Respir Crit Care Med. 2009;180(9):817-22. [Crossref] [PubMed]
- Chen R, Gao Y, Wang H, Shang H, Xuan J. Association between adherence to maintenance medication in patients with COPD and acute exacerbation occurrence and cost in China: a retrospective cohort database study. Int J Chron Obstruct Pulmon Dis. 2020;15:963-71. [Crossref] [PubMed] [PMC]
- World Health Organization. Adherence to long-term therapies: evidence for action/[edited by Eduardo Sabaté]. Geneva: World Health Organization; 2003. Cited: September 18, 2020. Available from: [Link]
- Tibble H, Flook M, Sheikh A, Tsanas A, Horne R, Vrijens B, et al. Measuring and reporting treatment adherence: what can we learn by comparing two respiratory conditions? Br J Clin Pharmacol. 2021;87(3):825-36. [Crossref] [PubMed]
- Freedman T. Medihaler therapy for bronchial asthma; a new type of aerosol therapy. Postgrad Med. 1956;20(6):667-73. [Crossref] [PubMed]
- Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al; Gruppo Educazionale Associazione Italiana Pneumologi Ospedalieri. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930-8. Erratum in: Respir Med. 2012;106(5):757. DelDonno, Mario [corrected to Del Donno, Mario]. [Crossref] [PubMed]
- Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J. 2015;45(2):396-407. [Crossref] [PubMed]
- Horne R. Compliance, adherence, and concordance: implications for asthma treatment. Chest. 2006;130(1 Suppl):65S-72S. [Crossref] [PubMed]
- Moran C, Doyle F, Sulaiman I, Bennett K, Greene G, Molloy GJ, et al. The INCATM (Inhaler Compliance AssessmentTM): A comparison with established measures of adherence. Psychol Health. 2017;32(10):1266-87. Erratum in: Psychol Health. 2017;32(10):i. [Crossref] [PubMed]
- Vestbo J, Anderson JA, Calverley PM, Celli B, Ferguson GT, Jenkins C, et al. Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax. 2009;64(11):939-43. [Crossref] [PubMed]
- van Boven JF, Trappenburg JC, van der Molen T, Chavannes NH. Towards tailored and targeted adherence assessment to optimise asthma management. NPJ Prim Care Respir Med. 2015;25:15046. [Crossref] [PubMed] [PMC]
- Bender BG, Pedan A, Varasteh LT. Adherence and persistence with fluticasone propionate/salmeterol combination therapy. J Allergy Clin Immunol. 2006;118(4):899-904. [Crossref] [PubMed]
- Mokoka MC, Lombard L, MacHale EM, Walsh J, Cushen B, Sulaiman I, et al. In patients with severe uncontrolled asthma, does knowledge of adherence and inhaler technique using electronic monitoring improve clinical decision making? A protocol for a randomised controlled trial. BMJ Open. 2017;7(6):e015367. [Crossref] [PubMed] [PMC]
- Sulaiman I, Cushen B, Greene G, Seheult J, Seow D, Rawat F, et al. Objective assessment of adherence to inhalers by patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195(10):1333-43. Erratum in: Am J Respir Crit Care Med. 2017;195(10 ):1407. [Crossref] [PubMed]
- Cushen B, Sulaiman I, Greene G, MacHale E, Mokoka M, Reilly RB, et al. The clinical impact of different adherence behaviors in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2018;197(12):1630-3. [Crossref] [PubMed]
- O'Dwyer S, Greene G, MacHale E, Cushen B, Sulaiman I, Boland F, et al. Personalized biofeedback on inhaler adherence and technique by community pharmacists: a cluster randomized clinical trial. J Allergy Clin Immunol Pract. 2020;8(2):635-44. [Crossref] [PubMed]
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