PREDICTORS OF PATIENT ADHERENCE TO LONG-TERM HOME NEBULIZER THERAPY FOR COPD

Study objective: Patients with moderate to severe COPD are frequently prescribed expensive and complicated therapies that require adjustment s in usual activities of daily living. However, little is known about factors that are associated with adherence to such treatment. The obje ctive of this study was to identify characteristics of patients who we re adherent to long-term home nebulizer therapy. Design: Patients were stratified into two adherence groups based on average minutes of nebu lizer use each day. A logistic regression model was developed to predi ct adherence based on baseline variables. A questionnaire was administ ered to patients to assess reasons for adherence to therapy. Setting: Five clinical centers in the United States and Canada. Participants: N ine hundred eighty-five patients with moderate to severe COPD enrolled in the Intermittent Positive Pressure Breathing (IPPB) Trial. Interve ntions: Long-term home IPPB and nebulizer therapy. Measurements and re sults: Altogether 50.6% of patients were adherent, and 49.4% were nona dherent. Among baseline variables, good adherence was predicted by whi te race, married status, abstinence from cigarettes and alcohol, serum theophylline level greater than or equal to 9 pg/mL, more severe dysp nea, and reduced FEV(1) (p<0.05). Subjects who were adherent to nebuli zer therapy were older, better educated, had a stable lifestyle, were more likely to report that the therapy made them feel better, and were more likely to keep clinic appointments. Conclusions: Sociodemographi c, physiologic, and quality of life variables were associated with adh erence to long-term nebulizer therapy.