O5.2 Inhaler adherence

Bhattarai et al (2020) conducted a systematic review of 38 studies published from 2003 to 2019 that examined rates of medication adherence and reported on barriers and enablers to adherence. Rates of non-adherence ranged from 22% to 93%. The majority of studies identified the presence of depression and subjects’ concern about the harmful effects of the medicine as barriers to adherence (Bhattarai 2020).

A systematic review comprising predominantly retrospective database studies which measured prescription refill adherence with one to two year follow-up of patients with COPD found increased hospitalizations, mortality, poor quality of life and loss of productivity among non-adherent patients (van Boven 2014) [evidence level III-2].  Inhaler adherence and technique were found to be suboptimal in an observational study of use of an ICS/LABA combination inhaler fitted with an electronic audio recording device. Impaired lung function and cognition, as well as cough, predicted suboptimal adherence and technique (Sulaiman 2017).

The National Asthma Council of Australia’s Australian Asthma Management Handbook contains further information about adherence: http://www.asthmahandbook.org.au/management/adherence.