title: The importance of inhaler devices: the choice of inhaler device may lead to suboptimal adherence in COPD patients.
abstract: OBJECTIVE
  This study aims to identify factors associated with poor adherence to COPD treatment in patients receiving a fixed-dose combination (FDC) of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA), focusing on the importance of inhaler devices.
  
  
  METHODS
  We conducted a retrospective and multicenter study based on a review of medical registries between 2007 and 2012 of COPD patients (n=1,263) treated with ICS/LABA FDC, whose medical devices were either dry powder inhalers (DPIs) or pressurized metered-dose inhalers (pMDI). Medication adherence included persistence outcomes through 18 months and medication possession ratios. Data on exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also included as confounders of adherence.
  
  
  RESULTS
  The analyses revealed that COPD patients whose medication was delivered through a DPI were less likely to have medication adherence compared to patients with pMDI, after adjusting for confounding factors, especially active ingredients. Younger groups of patients were less likely to be adherent compared to the oldest group. Smoker men were less likely to be adherent compared to women and non-smokers. Comorbidities decreased the probability of treatment adherence. Those patients that visited their doctor once a month were more likely to adhere to their medication regimen; however, suboptimal adherence was more likely to occur among those patients who visited more than three times per month their doctor. We also found that worsening of COPD is negatively associated with adherence.
  
  
  CONCLUSIONS
  According to this study, inhaler devices influence patients' adherence to long-term COPD medication. We also found that DPIs delivering ICS/LABA FDC had a negative impact on adherence. Patients' clinic and socioeconomic characteristics were associated with adherence.
authors.affiliation: Department of Economics, Universitat de Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Darbà
authors.affiliation: BCN Health Economics and Outcomes Research SL, Spain.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ramírez
authors.affiliation: Dirección de Planificación, Badalona Serveis Assistencials, SA, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras
authors.affiliation: Medical Department, TEVA Pharmaceutical, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Francoli
authors.affiliation: Market Access Department, TEVA Pharmaceutical Europe BV, Amsterdam, the Netherlands.
authors.forename: Saku
authors.initials: S
authors.lastname: Torvinen
authors.affiliation: Medical Department, TEVA Pharmaceutical, Madrid, Spain.
authors.forename: Rainel
authors.initials: R
authors.lastname: Sánchez-de la Rosa
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D015897:Comorbidity; D004338:Drug Combinations; D058995:Dry Powder Inhalers; D004867:Equipment Design; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D055118:Medication Adherence; D036501:Metered Dose Inhalers; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D004338:Drug Combinations
keywords: adherence; dry powder inhalers (DPIs); inhaler technique; medication possession ratio (MPR); persistence; pressurized metered-dose inhalers (pMDIs)