title: Low use and adherence to maintenance medication in chronic obstructive pulmonary disease in the general population.
abstract: OBJECTIVE
  We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD.
  
  
  METHODS
  We identified 5,812 individuals with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1-4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, long-acting anti-cholinergics, or long-acting beta2-agonists was identified in a nationwide registry. Use of medication was defined as medication dispensed during a one-year period , and adherence was calculated from dosages available in one year.
  
  
  RESULTS
  Use of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists varied from 2 % to 61 % (p < 0.001, test for trend), long-acting anti-cholinergics varied from 0.4 % to 36 % (p < 0.001), and long-acting beta2-agonists varied from 0.3 % to 11 % (p < 0.001. Among utilizers of these medications, adherence varied from 29 % to 56 % (p < 0.001, test for trend) across GOLD 1-4 for fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, from 51 % to 68 % (p = 0.11) for long-acting anti-cholinergics, and from 25 to 62 % (p = 0.01) for long-acting beta2-agonists.
  
  
  CONCLUSIONS
  Use of and adherence to maintenance medication for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low.
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark, trulsingebrigtsen@gmail.com.
authors.forename: Truls S
authors.initials: TS
authors.lastname: Ingebrigtsen
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Marott
authors.forename: Børge G
authors.initials: BG
authors.lastname: Nordestgaard
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
authors.forename: Morten
authors.initials: M
authors.lastname: Dahl
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D000368:Aged; D003718:Denmark; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012042:Registries; D012720:Severity of Illness Index
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D004338:Drug Combinations; D005938:Glucocorticoids