title: The influence of type of inhalation device on adherence of COPD patients to inhaled medication.
abstract: OBJECTIVE
  To study the influence of type of inhalation device on medication adherence of COPD patients.
  
  
  METHODS
  Adherence to inhalation medication of 795 patients was recorded from pharmacy records over 3 years. It was expressed as percentage and deemed good at ≥ 75-≤ 125%, sub-optimal ≥ 50-<75%, and poor <50% (underuse) or >125% (overuse). Since most patients used more than one device, 1379 medication periods were analyzed.
  
  
  RESULTS
  Patients using a Metered Dose Inhaler (MDI) or Diskus had a 2.3-fold and 2.2-fold increased risk, respectively, of suboptimal adherence versus good adherence, compared to Handihaler and a 2.1-fold and 2.2-fold increased risk, respectively, of underuse versus good adherence compared to Handihaler. Turbuhaler, MDI, Respimat had a 7.9-fold, 3.5-fold, and 2.0-fold increased risk, of overuse versus good adherence compared to Handihaler.
  
  
  CONCLUSIONS
  In COPD, adherence to inhalation medication is device-related. Overuse was most pronounced for devices without a dose counter, devices with the ability to load a dosage without actual inhalation, or devices lacking feedback of correct inhalation. The design of the device seems to be related to underuse and overuse of inhaled medication. Future research might investigate whether prescribing a different device with similar medication improves therapy adherence.
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; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016903:Drug Monitoring
keywords: Adherence; COPD; inhalation device; lung function