Factors associated with inhaler therapy adherence using a multidimensional adherence model in patients with chronic obstructive pulmonary disease.

Abstract

To investigate factors associated with adherence to inhaler therapy in patients with chronic obstructive pulmonary disease (COPD) by using the Multidimensional Adherence Model (MAM). The study was conducted with individuals hospitalized for COPD in a hospital for chest diseases. Data were collected across five dimensions based on the MAM framework (socio-economic, patient-related, condition-related, treatment-related, and healthcare system-related factors). The Test of Adherence to Inhalers was used to assess adherence; the Patient Health Questionnaire-9 and the COPD Self-Efficacy Scale were used to assess depression levels and self-efficacy, respectively, as part of patient-related factors. Of the 300 patients with COPD in the study, 68.3% were non-adherent to inhaler therapy. Bivariate analysis showed significant differences between adherent and non-adherent groups regarding socio-economic (education, employment), patient-related (age, family support, depression, self-efficacy), condition-related (comorbidities, years with COPD, COPD stage, number of hospitalizations and emergency visits), and healthcare system-related factors (distance from home to hospital, receiving disease-related education) (p < 0.05). Multivariable analysis showed that comorbidity (OR = 0.28, 95% CI 0.22-0.46; 72% lower odds of adherence), number of emergency visits (OR = 0.92, 95% CI 0.85-0.98; 8% lower odds per additional visit), and receiving disease-related education (OR = 7.67, 95% CI 3.65-16.12; 7.67-fold higher odds of adherence) were independently associated with adherence. The findings highlight the need for targeted interventions, especially for those with comorbidities, frequent emergency visits, and a lack of disease-related education, to improve medication adherence in patients with COPD. Improving inhaler adherence in COPD may benefit from structured patient education programs, post-discharge follow-up after emergency visits, and nurse-led or multidisciplinary adherence monitoring strategies.