title: Objective Assessment of Adherence to Inhalers by Patients with Chronic Obstructive Pulmonary Disease.
abstract: Objective adherence to inhaled therapy by patients with chronic obstructive pulmonary disease (COPD) has not been reported.
  
  
  
  To objectively quantify adherence to preventer Diskus inhaler therapy by patients with COPD with an electronic audio recording device (INCA).
  
  
  
  This was a prospective observational study. On discharge from hospital patients were given a salmeterol/fluticasone inhaler with an INCA device attached. Analysis of this audio quantified the frequency and proficiency of inhaler use.
  
  
  
  Patients with COPD (n = 244) were recruited. The mean age was 71 years, mean FEV1was 1.3 L, and 59% had evidence of mild/moderate cognitive impairment. By combining time of use, interval between doses, and critical technique errors, thus incorporating both intentional and unintentional nonadherence, a measure "actual adherence" was calculated. Mean actual adherence was 22.6% of that expected if the doses were taken correctly and on time. Six percent had an actual adherence greater than 80%. Hierarchical clustering found three equally sized well-separated clusters corresponding to distinct patterns. Cluster 1 (34%) had low inhaler use and high error rates. Cluster 2 (25%) had high inhaler use and high error rates. Cluster 3 (36%) had overall good adherence. Poor lung function and comorbidities were predictive of poor technique, whereas age and cognition with poor lung function distinguished those with poor adherence and frequent errors in technique.
  
  
  
  These data may inform clinicians in understanding why a prescribed inhaler is not effective and to devise strategies to promote adherence in COPD.
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Imran
authors.initials: I
authors.lastname: Sulaiman
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Breda
authors.initials: B
authors.lastname: Cushen
authors.affiliation: 2 Department of Psychology.
authors.forename: Garrett
authors.initials: G
authors.lastname: Greene
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Jansen
authors.initials: J
authors.lastname: Seheult
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Dexter
authors.initials: D
authors.lastname: Seow
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Fiona
authors.initials: F
authors.lastname: Rawat
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Elaine
authors.initials: E
authors.lastname: MacHale
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Matshediso
authors.initials: M
authors.lastname: Mokoka
authors.affiliation: 2 Department of Psychology.
authors.forename: Catherine Nora
authors.initials: CN
authors.lastname: Moran
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Aoife
authors.initials: A
authors.lastname: Sartini Bhreathnach
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Philippa
authors.initials: P
authors.lastname: MacHale
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Shahed
authors.initials: S
authors.lastname: Tappuni
authors.affiliation: 3 COPD Outreach, Beaumont Hospital, Dublin, Ireland; and.
authors.forename: Brenda
authors.initials: B
authors.lastname: Deering
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Mandy
authors.initials: M
authors.lastname: Jackson
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.
authors.forename: Hannah
authors.initials: H
authors.lastname: McCarthy
authors.affiliation: 2 Department of Psychology.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mellon
authors.affiliation: 2 Department of Psychology.
authors.forename: Frank
authors.initials: F
authors.lastname: Doyle
authors.affiliation: 4 Division of Population Health Sciences, and.
authors.forename: Fiona
authors.initials: F
authors.lastname: Boland
authors.affiliation: 5 Trinity Centre of Bioengineering.|6 School of Engineering, and.|7 School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Reilly
authors.affiliation: 1 Clinical Research Centre, Beaumont Hospital.|8 Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Costello
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D000068298:Fluticasone / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D000068299:Salmeterol Xinafoate / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D001993:Bronchodilator Agents; D004338:Drug Combinations; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone
keywords: COPD; adherence; compliance; exacerbations; inhaler