title: Quality of life and adherence to inhaled corticosteroids and tiotropium in COPD are related.
abstract: BACKGROUND
  Poor adherence to inhaled medications in COPD patients seems to be associated with an increased risk of death and hospitalization. Knowing the determinants of nonadherence to inhaled medications is important for creating interventions to improve adherence.
  
  
  OBJECTIVE
  To identify disease-specific and health-related quality of life (HRQoL) factors, associated with adherence to inhaled corticosteroids (ICS) and tiotropium in COPD patients.
  
  
  METHODS
  Adherence of 795 patients was recorded over 3 years and was deemed optimal at >75%-≤125%, suboptimal at ≥50%-<75%, and poor at <50% (underuse) or >125% (overuse). Health-related quality of life was measured with the Clinical COPD Questionnaire and the EuroQol-5D questionnaire.
  
  
  RESULTS
  Patients with a higher forced expiratory volume in 1 second (FEV1)/vital capacity (VC) (odds ratio [OR] =1.03) and ≥1 hospitalizations in the year prior to inclusion in this study (OR =2.67) had an increased risk of suboptimal adherence to ICS instead of optimal adherence. An increased risk of underuse was predicted by a higher FEV1/VC (OR =1.05). Predictors for the risk of overuse were a lower FEV1 (OR =0.49), higher scores on Clinical COPD Questionnaire-question 3 (anxiety for dyspnea) (OR =1.26), and current smoking (OR =1.73). Regarding tiotropium, predictors for suboptimal use were a higher FEV1/VC (OR =1.03) and the inability to perform usual activities as asked by the EuroQol-5D questionnaire (OR =3.09). A higher FEV1/VC also was a predictor for the risk of underuse compared to optimal adherence (OR =1.03). The risk of overuse increased again with higher scores on Clinical COPD Questionnaire-question 3 (OR =1.46).
  
  
  CONCLUSIONS
  Several disease-specific and quality of life factors are related to ICS and tiotropium adherence, but a clear profile of a nonadherent patient cannot yet be outlined. Overusers of ICS and tiotropium experience more anxiety.
authors.affiliation: Department of Pulmonary Medicine.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Koehorst-Ter Huurne
authors.affiliation: Department of Pulmonary Medicine.
authors.forename: Sharina
authors.initials: S
authors.lastname: Kort
authors.affiliation: Department of Pulmonary Medicine; Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: Department of Pulmonary Medicine.
authors.forename: Wendy Jc
authors.initials: WJ
authors.lastname: van Beurden
authors.affiliation: Department of Clinical Pharmacy, Medisch Spectrum Twente.
authors.forename: Kris Ll
authors.initials: KL
authors.lastname: Movig
authors.affiliation: Department of Pulmonary Medicine.
authors.forename: Paul
authors.initials: P
authors.lastname: van der Valk
authors.affiliation: Department of Pulmonary Medicine.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
mesh_terms: D000203:Activities of Daily Living; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D018680:Cholinergic Antagonists / Q000008:administration & dosage*; D004417:Dyspnea / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D000069447:Tiotropium Bromide / Q000008:administration & dosage*; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D000069447:Tiotropium Bromide
keywords: adherence; chronic obstructive pulmonary disease; inhalation medication; quality of life