Nonadherence in chronic obstructive pulmonary disease patients: what do we know and what should we do next?
OBJECTIVE
Although nonadherence research in patients with chronic obstructive pulmonary disease (COPD) lags well behind other diseases, new evidence helps inform understanding about the degree and underlying causes of patient nonadherence, interventions that can improve adherence, and areas of research needed to further progress in improving this problem in patients with COPD.


RESULTS
Fewer than half of treatments for COPD, including oxygen supplementation, physical rehabilitation, and medication, are taken as prescribed. Most patients abandon their treatment after an initial start. Nonadherence in turn contributes to rising rates of hospitalization, death, and healthcare costs. The reasons why patients choose not to use their COPD treatments are not fully understood, although depression is clearly a contributing factor. Although a substantial number of studies have tested adherence interventions, few have included COPD patients or addressed polypharmacy in patients with multiple comorbidities.


CONCLUSIONS
The paucity of research does not reflect the inadequacy of available treatments. Lessons learned from the research outside of COPD and a small number of COPD studies suggest that a collaborative care approach will likely provide the most potential for improving overall care, including management of depression and enhancement of adherence. Exploitation of mobile telephone technology to engage patients in a discussion of their self-care should not be ignored as a potential intervention for COPD patients.
Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.
Bruce G
BG
Bender
D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D040421:Cell Phone; D015897:Comorbidity; D003863:Depression / Q000209:etiology; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D009042:Motivation; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D017010:Reminder Systems; D012307:Risk Factors; D012648:Self Care / Q000523:psychology; D014481:United States
D001993:Bronchodilator Agents