Enhancing adherence in patients with COPD: Targets, interventions & cost-effectiveness

Individuals with a chronic lung disease, such as COPD, are dependent on the use of inhaled medication. These medications can substantially reduce dyspnea and prevent exacerbations. However, they are only optimally effective when used on a daily basis and with a correct inhalation technique (this is called “adherence”). The majority of patients have major difficulties in being or remaining adherent. In this research project we found that COPD patients who used their medication sub-optimally (non-adherent patients), were more often hospitalized, had lower quality of life and also decreased life expectation. In addition, total healthcare costs were higher and these patients showed higher work productivity losses. We also discovered that side-effects are common after the start of new inhaled lung medication, especially in the first three months, but even after a year of use, they still occur. This is often related to incorrect inhalation technique. Obviously, we should not blame the COPD patients themselves for this. However, it highlights that physicians and pharmacists should spent more time on educating their patients on how to use their inhaled medication in a correct manner. Therefore, we subsequently investigated the effectiveness and cost-effectiveness of enhancing adherence, in The Netherlands as well as in Belgium. In both countries it appeared that patients that received extra education and instruction had fewer hospitalizations at lower total healthcare costs as compared to COPD patients receiving standard care. We concluded that optimizing medication adherence should therefore always be considered before starting new, often more expensive, therapies.