Cs. Rand et al., LONG-TERM METERED-DOSE INHALER ADHERENCE IN A CLINICAL-TRIAL, American journal of respiratory and critical care medicine, 152(2), 1995, pp. 580-588
Citations number
26
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
Poor adherence to medication regimens is a well-documented phenomenon
in clinical practice and an ever-present concern in clinical trials. L
ittle is known about adherence to inhaled medication regimens over ext
ended periods. The present paper describes the 2-yr results of the Lun
g Health Study (LHS) program, which was developed to maintain long-ter
m adherence to an inhaled medication regimen in 3,923 special interven
tion participants (as measured by self-report and medication canister
weight). The LHS is a double-blind, multicenter, randomized controlled
clinical trial of smoking intervention and bronchodilator therapy (ip
ratropium bromide or placebo) for early intervention in chronic obstru
ctive pulmonary disease (COPD). At the first 4-mo follow-up visit, nea
rly 70% of participants reported satisfactory or better adherence. Ove
r the next 18 mo, self-reported satisfactory or better adherence decli
ned to about 60%. Canister weight classified adherence as satisfactory
or better in 72% of participants returning all canisters at 1 yr, and
in 70% of the participants returning all canisters at the 2-yr follow
-up. Self-reporting confirmed by canister weight classified 48% of par
ticipants at 1 yr as showing satisfactory or better adherence. Overuse
rs were 50% more likely than others to misrepresent their true smoking
status, suggesting that canister weights indicating overuse may be de
ceptive. Results of multiple logistic regression analysis indicate tha
t the best compliance was found in participants who were married, olde
r, white, had more severe airways obstruction, less shortness of breat
h, and fewer hospitalizations, and who had not been confined to bed fo
r respiratory illnesses. In summary, a structured program for promotin
g adherence to an inhaled medication regimen was successful in achievi
ng initial satisfactory adherence in the majority of participants; how
ever, adherence declined notably from the conclusion of this program t
o the first-year follow-up, and more gradually over the second year.