Can simple approaches improve medication adherence in people with COPD?

Can simple approaches improve medication adherence in people with COPD?

Vanessa Jordan
PEARLS No.
686
Clinical question

How effective and safe are interventions intended to improve adherence to pharmacological treatments, compared with usual care, in people with chronic obstructive pulmonary disease?

Bottom line

Single-component interventions, such as provision of education or motivational interviewing by a health professional, can help improve adherence to pharmacotherapy. Similarly, single-component interventions may also help improve quality of life.

Multi‐component interventions, which can include structured education and motivational or behavioural components provided by a health professional, may also help improve medication adherence in people who have mild to severe COPD for medium to long‐term duration.

Low to moderate‐certainty evidence shows that pharmacist‐led approaches may be beneficial in reducing the number of people admitted to hospital (for any reason or COPD related).

There was no apparent difference in the number of people experiencing exacerbations, adverse events, serious adverse events or deaths between those receiving interventions to improve adherence and those who did not.

Caveat

The evidence presented in this review should be interpreted with caution as most of the evidence was of low to very low certainty for single-component interventions, and of moderate to very low certainty for multi‐component interventions. Larger studies are needed to demonstrate effects and optimal durations of single and multi‐component interventions in different COPD populations.

Context

COPD is a progressive, chronic lung disease characterised by persistent respiratory symptoms and limited airflow due to airway or alveolar abnormalities (or both). Adherence to medication is one of the most important factors in enabling successful treatment of COPD. Benefits to clinical outcomes are often limited due to people not taking medication as prescribed, which can also be costly and wasteful for health services.

Cochrane Systematic Review

Janjua S, et al. Interventions to improve adherence to pharmacological therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2021;9:CD013381. This review contains 14 trials with a total of 2191 participants.