title: Differences in Adherence to Common Inhaled Medications in COPD.
abstract: OBJECTIVE
  To study differences in adherence to common inhaled medications in COPD.
  
  
  METHODS
  Adherence of 795 patients was recorded from pharmacy records over 3 years in the COMIC cohort. It was expressed as percentage and deemed good at ≥75-≤125%, sub-optimal ≥50-<75%, and poor <50% (underuse) or >125% (overuse). Most patients used more than one medication, so we present 1379 medication periods.
  
  
  RESULTS
  The percentages of patients with good therapy adherence ranged from 43.2 (beclomethasone) -75.8% (tiotropium); suboptimal from 2.3 (budesonide) -23.3% (fluticasone); underuse from 4.4 (formoterol/budesonide) -18.2% (beclomethasone); and overuse from 5.1 (salmeterol) -38.6% (budesonide). Patients using fluticasone or salmeterol/fluticasone have a 2.3 and 2.0-fold increased risk of suboptimal versus good adherence compared to tiotropium. Patients using salmeterol/fluticasone or beclomethasone have a 2.3- and 4.6-fold increased risk of underuse versus good adherence compared to tiotropium. Patients using budesonide, salmeterol/fluticasone, formoterol/budesonide, ciclesonide and beclomethasone have an increased risk of overuse versus good adherence compared to tiotropium. Adherence to inhalation medication is inversely related to lung function.
  
  
  CONCLUSIONS
  Therapy adherence to inhalation medication for the treatment of COPD is in our study related to the medication prescribed. Tiotropium showed the highest percentage of patients with good adherence, followed by ciclesonide, both dosed once daily. The idea of improving adherence by using combined preparations cannot be confirmed in this study. Further research is needed to investigate the possibilities of improving adherence by changing inhalation medication.
authors.affiliation: a Department of Pulmonary Medicine , Medisch Spectrum Twente , Enschede , the Netherlands.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Koehorst-ter Huurne
authors.affiliation: b Department of Clinical Pharmacy , Medisch Spectrum Twente , Enschede , the Netherlands.
authors.forename: Kris
authors.initials: K
authors.lastname: Movig
authors.affiliation: a Department of Pulmonary Medicine , Medisch Spectrum Twente , Enschede , the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: van der Valk
authors.affiliation: a Department of Pulmonary Medicine , Medisch Spectrum Twente , Enschede , the Netherlands.|c Department of Research Methodology , Measurement, and Data Analysis, University of Twente , Enschede , Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: a Department of Pulmonary Medicine , Medisch Spectrum Twente , Enschede , the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000523:psychology; D013997:Time Factors
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D005938:Glucocorticoids
keywords: COPD; adherence; inhalation medication; lung function