title: Adherence to long-acting inhaled therapies among patients with chronic obstructive pulmonary disease (COPD).
abstract: BACKGROUND
  Long-acting inhaled medications are an important component of the treatment of patients with chronic obstructive pulmonary disease (COPD), yet few studies have examined the determinants of medication adherence among this patient population.
  
  
  OBJECTIVE
  We sought to identify factors associated with adherence to long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) among patients with COPD.
  
  
  METHODS
  We performed secondary analysis of baseline data collected in a randomized trial of 376 Veterans with spirometrically confirmed COPD. We used electronic pharmacy records to assess adherence, defined as a medication possession ratio of ≥0.80. We investigated the following exposures: patient characteristics, disease severity, medication regimen complexity, health behaviors, confidence in self-management, and perceptions of provider skill. We performed multivariable logistic regression, clustered by provider, to estimate associations.
  
  
  RESULTS
  Of the 167 patients prescribed LABA, 54% (n = 90) were adherent to therapy while only 40% (n = 74) of 184 the patients prescribed ICS were adherent. Higher adherence to LABA and ICS was associated with patient perception of their provider as being an "expert" in diagnosing and managing lung disease [For LABA: OR = 21.70 (95% CI 6.79, 69.37); For ICS OR = 7.93 (95% CI 1.71, 36.67)]. Factors associated with adherence to LABA, but not ICS, included: age, education, race, COPD severity, smoking status, and confidence in self-management.
  
  
  CONCLUSIONS
  Adherence to long-acting inhaled medications among patients with COPD is poor, and determinants of adherence likely differ by medication class. Patient perception of clinician expertise in lung disease was the factor most highly associated with adherence to long-acting therapies.
authors.affiliation: Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98101, USA. lcecere@u.washington.edu
authors.forename: Laura M
authors.initials: LM
authors.lastname: Cecere
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.forename: Jane E
authors.initials: JE
authors.lastname: Uman
authors.forename: Laura E
authors.initials: LE
authors.lastname: Evans
authors.forename: Edmunds M
authors.initials: EM
authors.lastname: Udris
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012720:Severity of Illness Index; D012907:Smoking
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents