title: COPD: adherence to therapy.
abstract: Adherence to medical therapies is a growing issue, so much so that the World Health Organization defined it as "a new pharmacological problem". The main factors affecting compliance are: frequency of administration, rapid onset of action, role of device. The most severe consequence of non-adherence is the increased risk of poor clinical outcome, associated with worsening of the quality of life and increase in health-care expenditure. It appears crucial to identify those COPD patients who are "poorly or not at all compliant with their treatment". In order to evaluate adherence to the medical therapy, several methods were proposed, the most effective of which turned out to be self-reports, i.e. simple, brief questionnaires (e.g. Morisky test). To increase the likelihood of quickly identifying non-compliant patients, it may be useful to administer a simple questionnaire to naïve subjects (for example, in the waiting room before an examination) including six specific items allowing to identify the patient's key characteristics. Depending on the answers, patients who do not comply with their pharmacological treatment may be classified as belonging to 6 phenotypes. For patients who are already under treatment it might be useful to administer another short questionnaire during follow up examination. Once the risk of non-compliance is identified, four possible types of measures can be taken: prescription-related, educational, behavioral and complex combined measures (combination of two or more actions). Therefore, while it is clear that adherence in COPD is a critical issue, it is also obvious that raising awareness on the disease and improving cooperation among specialists, general practitioners, health-care professionals, and patients is the starting point at which this evolution should immediately begin. Each medication is able to foster good compliance with the therapy, and consequently to maximize the efficacy, by virtue of its specific inhaler and its own active ingredient.
authors.affiliation: Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanduzzi
authors.affiliation: Pneumology Thoracic Unit, Ospedale Maggiore della Carità, Novara, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Balbo
authors.affiliation: Pulmonary and Endoscopic Thoracic Unit, AUSL, Ravenna, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Candoli
authors.affiliation: Clinical Researcher, Respiratory Diseases, Institute of Clinical Physiology, G. Monasterio Tuscany Foundation/National Research Council, Pisa, Italy.
authors.forename: Giousuè A
authors.initials: GA
authors.lastname: Catapano
authors.affiliation: Department of Respiratory Diseases, Bellaria Hospital, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Contini
authors.affiliation: Department of Pulmonary Diseases, Città della Salute e della Scienza Molinette, Torino, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Mattei
authors.affiliation: Department of Pulmonary Diseases, S. Camillo - Forlanini Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Puglisi
authors.affiliation: Pharmacology Specialist, ASL, Bari, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoiemma
authors.affiliation: Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy.
authors.forename: Anna A
authors.initials: AA
authors.lastname: Stanziola
keywords: Adherence; COPD; Inhaler; LABA; LAMA; Questionnaire