A hospital-based exploration of medication adherence among outpatients with COPD: implications for clinical practice
Main Article Content
Keywords
COPD, adherence, medication, inhaler, patient
Abstract
Background: The management of COPD typically involves a multifaceted approach and a complex treatment regimen. Poor adherence to prescribed
medications can lead to worsened symptoms, increased exacerbations, and reduced quality of life among patients with COPD.
Objective: This study aimed to assess medication adherence and associated factors in outpatients with COPD, which remain insufficiently investigated.
Methods: A cross-sectional study was conducted at outpatient respiratory clinics in two major Jordanian hospitals. Data collection included sociodemographic and medical parameters. Medication adherence was assessed using a validated Arabic 4-item scale.Logistic regression was conducted to
identify the variables associated with medication adherence.
Results: Of the 702 participants, 68%reported poor medication adherence. Key determinants of medication adherence included age, inhaler technique,
knowledge, comorbidities, concerns about side effects, dosing frequency, disease duration, and depression.
Conclusion: Medication adherence in COPD patients, particularly in the elderly, and those with comorbidities, depression, and longer disease duration, is
inadequate. Effective counselling and more convenient medication regimens are essential to improving adherence in this patient population.
References
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University Students in Palestine, Jordan, and Turkey. Asian Pac J Cancer Prev. 2022;23(4):1247–56. https://doi.org/10.31557/APJCP.2022.23.4.1247
3. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive
pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013 Feb 15;187(4):347–65. https://doi.org/10.1164/
RCCM.201204-0596PP
4. Sweis NJ. Smoking Behavior among Jordanians: Physical, Psychological, Social, and Economic Reasons. Value Heal Reg issues.
2018 Sep 1;16:5–8. https://doi.org/10.1016/J.VHRI.2017.09.003
5. Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022 May 1;10(5):447–58. https://doi.org/10.1016/S2213-2600(21)00511-7
6. Koskela J, Kilpeläinen M, Kupiainen H, et al. Co-morbidities are the key nominators of the health related quality of life in mild
and moderate COPD. BMC Pulm Med. 2014 Jun 19;14(1):102. https://doi.org/10.1186/1471-2466-14-102/TABLES/4
7. López-Campos JL, Gallego EQ, Hernández LC. Status of and strategies for improving adherence to COPD treatment. Int J Chron Obstruct Pulmon Dis. 2019;14:1503–15. https://doi.org/10.2147/COPD.S170848
8. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.
9. Al Bawab AQ, Al-Qerem W, Abusara O, et al. What Are the Factors Associated with Nonadherence to Medications in Patients
with Chronic Diseases? Healthcare. 2021 Sep 20;9(9):1237. https://doi.org/10.3390/HEALTHCARE9091237
10. Restrepo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct
Pulmon Dis. 2008;3(3):371–84. https://doi.org/10.2147/COPD.S3036
11. Jarab AS, Mukattash TL. Exploring variables associated with medication non-adherence in patients with COPD. Int J Clin Pharm. 2019 Aug 30;41(5):1202–9. https://doi.org/10.1007/S11096-019-00895-3
12. Volpato E, Toniolo S, Pagnini F, et al. The Relationship Between Anxiety, Depression and Treatment Adherence in Chronic
Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis. 2021;16:2001–21. https://doi.org/10.2147/COPD.S313841
13. Agh T, Inotai A, Meszaros A. Factors associated with medication adherence in patients with chronic obstructive pulmonary
disease. Respiration. 2011;82(4):328–34. https://doi.org/10.1159/000324453
14. Ierodiakonou D, Sifaki-Pistolla D, Kampouraki M, et al. Adherence to inhalers and comorbidities in COPD patients. A crosssectional primary care study from Greece. BMC Pulm Med. 2020;20:253. https://doi.org/10.1186/S12890-020-01296-3
15. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983 Jun 1;67(6):361–70. https://doi.org/10.1111/J.1600-0447.1983.TB09716.X
16. Lichtenberg PA. Handbook of Assessment in Clinical Gerontology. 2nd Ed. Academic Press; 2010.
17. Mahler DA. mMRC (Modified Medical Research Council) Dyspnea Scale [Internet]. MDCalc. [cited 2022 Apr 27]. Available
from: https://www.mdcalc.com/mmrc-modified-medical-research-council-dyspnea-scale#use-cases
18. Laisure M, Covill N, Ostroff ML, et al. Summarizing the 2021 Updated GOLD Guidelines for COPD [Internet]. 2022 [cited 2023
May 29]. Available from: https://www.medscape.com/viewarticle/955946_2
19. The Deutsche Atemwegsliga e.V. (German Airway League) Correct Inhalation Technique [Internet]. 2019 [cited 2022 Apr 28].
Available from: https://www.atemwegsliga.de/correct-inhalation.html
20. Awwad O, AlMuhaissen S, Al-Nashwan A, et al. Translation and validation of the Arabic version of the Morisky, Green and
Levine (MGL) adherence scale. PLoS One. 2022;17(10):e0275778. https://doi.org/10.1371/journal.pone.0275778
21. Karamurugan S, Govindarajan B. Statistical Package for the Social Science. Int J Bus Econ Res. 2023 Jan;8(4):616–8.
22. Davis JR, Wu B, Kern DM, et al. Impact of nonadherence to inhaled corticosteroid/LABA therapy on COPD exacerbation ratesand healthcare costs in a commercially insured US population. Am Heal Drug Benefits. 2017;10(2):92–100.
23. Napolitano F, Napolitano P, Angelillo IF. Medication adherence among patients with chronic conditions in Italy. Eur J Public
Health. 2016;26(1):48–52. https://doi.org/10.1093/eurpub/ckv147
24. Acharya S, Sharma K. Factors affecting medication adherence among chronic obstructive pulmonary disease patients attending at teaching Hospital, Chitwan. Int J Med Sci Public Heal. 2019;8(7):498–503. https://doi.org/10.5455/ijmsph.2019.0409905052019
25. Galal IH, Mohammad YM, Nada AA, et al. Medication adherence and treatment satisfaction in some Egyptian patients with
chronic obstructive pulmonary disease and bronchial asthma. Egypt J Bronchol. 2018;12(1):33–40. https://doi.org/10.4103/
ejb.ejb
26. Koehorst-Ter Huurne K, Kort S, Van Der Palen J, et al. Quality of life and adherence to inhaled corticosteroids and tiotropium in COPD are related. Int J COPD. 2016;11(1):1679–88. https://doi.org/10.2147/COPD.S107303
27. Peng Y, Duan J, Li X, et al. Adherence to inhaled therapy in patients with COPD associated to pneumoconiosis. Int J COPD.
2021;16:2697–706. https://doi.org/10.2147/COPD.S327686
28. Vetrano DL, Bianchini E, Onder G, et al. Poor adherence to chronic obstructive pulmonary disease medications in primary care: Role of age, disease burden and polypharmacy. Geriatr Gerontol Int. 2017 Dec 1;17(12):2500–6. https://doi.org/10.1111/GGI.13115
29. Kokturk N, Polatli M, Oguzulgen IK, et al. Adherence to COPD treatment in turkey and Saudi Arabia: Results of the ADCARE
study. Int J COPD. 2018;13:1377–88. https://doi.org/10.2147/COPD.S150411
30. Mueller S, Wilke T, Bechtel B, et al. Non-persistence and non-adherence to long-acting COPD medication therapy: A
retrospective cohort study based on a large German claims dataset. Respir Med. 2017;122:1–11. https://doi.org/10.1016/j.rmed.2016.11.008
31. Arfè A, Nicotra F, Cerveri I, et al. Incidence, Predictors, and Clinical Implications of Discontinuing Therapy with Inhaled
Long-Acting Bronchodilators among Patients with Chronic Obstructive Pulmonary Disease. COPD J Chronic Obstr Pulm Dis.
2016;13(5):540–6. https://doi.org/10.3109/15412555.2016.1141877
32. Humenberger M, Kaiser B, Labek A, et al. Adherence to inhaled therapy and its impact on chronic obstructive pulmonary
disease (COPD). BMC Pulm Med. 2018;18:163–8. https://doi.org/10.1183/13993003.congress-2016.pa3684
33. Monteiro C, Maricoto T, Prazeres F, et al. Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literature. Respir Med. 2022;191:106724. https://doi.org/10.1016/j.rmed.2021.106724
34. Hanania NA, Sharma G, Sharafkhaneh A. COPD in the elderly patient. Semin Respir Crit Care Med. 2010;31(5):596–606. https://doi.org/10.1055/S-0030-1265900
35. Sánchez-Nieto JM, Bernabeu-Mora R, Fernández-Muñoz I, et al. Effectiveness of individualized inhaler technique training
on low adherence (LowAd) in ambulatory patients with COPD and asthma. npj Prim Care Respir Med 2022 321. 2022 Jan
10;32(1):1–9. https://doi.org/10.1038/s41533-021-00262-8
36. Leiva-Fernández J, Leiva-Fernández F, García-Ruiz A, et al. Efficacy of a multifactorial intervention on therapeutic adherence
in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled trial. BMC Pulm Med. 2014 Apr
25;14(1):70. https://doi.org/10.1186/1471-2466-14-70
37. Van Boven JFM, Chavannes NH, Van Der Molen T, et al. Clinical and economic impact of non-adherence in COPD: A systematic review. Respir Med. 2014;108(1):103–13. https://doi.org/10.1016/j.rmed.2013.08.044
38. Vestbo J, Anderson JA, Calverley PMA, et al. Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax. 2009;64(11):939–43. https://doi.org/10.1136/thx.2009.113662
39. Khdour MR, Hawwa AF, Kidney JC, et al. Potential risk factors for medication non-adherence in patients with chronic obstructive pulmonary disease (COPD). Eur J Clin Pharmacol. 2012;68(10):1365–73. https://doi.org/10.1007/s00228-012-1279-5
40. Bhattarai B, Walpola R, Mey A, et al. Barriers and strategies for improving medication adherence among people living with
COPD: A systematic review. Respir Care. 2020;65(11):1738–50. https://doi.org/10.4187/respcare.07355
41. Qian J, Simoni-Wastila L, Rattinger GB, et al. Association between depression and maintenance medication adherence among Medicare beneficiaries with chronic obstructive pulmonary disease. Int J Geriatr Psychiatry. 2014 Jan;29(1):49–57. https://doi.org/10.1002/GPS.3968
42. Turan O, Yemez B, Itil O. The effects of anxiety and depression symptoms on treatment adherence in COPD patients. Prim
Health Care Res Dev. 2014 Jul 1;15(3):244–51. https://doi.org/10.1017/S1463423613000169
43. Albrecht JS, Park Y, Hur P, et al. Adherence to maintenance medications among older adults with chronic obstructive pulmonary disease the role of depression. Ann Am Thorac Soc. 2016 Sep 1;13(9):1497–504. https://doi.org/10.1513/ANNALSATS.201602-136OC
44. Fischer W, Brandstetter S, Brandl M, et al. Specific, but not general beliefs about medicines are associated with medication
adherence in patients with COPD, but not asthma: Cohort study in a population of people with chronic pulmonary disease. J
Psychosom Res. 2018 Apr 1;107:46–52. https://doi.org/10.1016/J.JPSYCHORES.2018.02.004
45. Krauskopf K, Federman AD, Kale MS, et al. Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence. COPD J Chronic Obstr Pulm Dis. 2015 Apr 14;12(2):151–64. https://doi.org/10.3109/15412555. 2014.922067
46. Alefishat E, Jarab AS, Al-Qerem W, et al. Factors associated with medication non-adherence in patients with dyslipidemia.
Healthc. 2021 Jul 1;9(7):3–12. https://doi.org/10.3390/healthcare9070813
47. Jarab AS, Abu Heshmeh SR, Al-Qerem WA, et al. Non-adherence to pharmacotherapy and its associated factors in outpatients with rheumatoid arthritis. Pharm Pract (Granada). 2023 Jun 30;21(2):1–8. https://doi.org/10.18549/PharmPract.2023.2.2822
48. Santos PDM, D’Oliveira A, De Araújo Costa Beisl Noblat L, et al. Predictors of treatment adhering in patients with severe asthma treated at a referral center in Bahia. J Bras Pneumol. 2008 Dec;34(12):995–1002. https://doi.org/10.1590/S180637132008001200003
49. Toy EL, Beaulieu NU, McHale JM, et al. Treatment of COPD: relationships between daily dosing frequency, adherence, resource use, and costs. Respir Med. 2011 Mar;105(3):435–41. https://doi.org/10.1016/J.RMED.2010.09.006
50. Coleman CI, Limone B, Sobieraj DM, et al. Dosing frequency and medication adherence in chronic disease. J Manag care
Pharm. 2012;18(7):527–39. https://doi.org/10.18553/JMCP.2012.18.7.527
51. Weeda ER, Coleman CI, McHorney CA, et al. Impact of once- or twice-daily dosing frequency on adherence to chronic cardiovascular disease medications: A meta-regression analysis. Int J Cardiol. 2016 Aug 1;216:104–9. https://doi.org/10.1016/j.ijcard.2016.04.082
52. Rafi MA, Tahmin CI, Tashrik S, et al. Adherence to inhalers and associated factors among adult asthma patients: an outpatientbased study in a tertiary hospital of Rajshahi, Bangladesh. Asthma Res Pract. 2022 Dec;8(1):1. https://doi.org/10.1186/S40733-022-00083-7
53. Mathes T, Jaschinski T, Pieper D. Adherence influencing factors - a systematic review of systematic reviews. Arch Public Heal.
2014 Oct 27;72(1):1–9. https://doi.org/10.1186/2049-3258-72-37/TABLES/3
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May 9, 2025
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A hospital-based exploration of medication adherence among outpatients with COPD: implications for clinical practice. Pharm Pract (Granada) [Internet]. 2025 May 9 [cited 2025 Jul. 16];23(2):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3142
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How to Cite
1.
A hospital-based exploration of medication adherence among outpatients with COPD: implications for clinical practice. Pharm Pract (Granada) [Internet]. 2025 May 9 [cited 2025 Jul. 16];23(2):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3142