Restrepo Ruben D, Alvarez Melissa T, Wittnebel Leonard D, Sorenson Helen, Wettstein Richard, Vines David L, Sikkema-Ortiz Jennifer, Gardner Donna D, Wilkins Robert L
Department of Respiratory Care, The University of Texas Health Science Center at San Antonio,Texas 78229, USA.
Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-84. doi: 10.2147/copd.s3036.
Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%-60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient's selection of both the device and the regimen. Patient's health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence.
尽管慢性阻塞性肺疾病（COPD）的医学治疗已有进展，但不坚持药物治疗方案对优化管理构成了重大障碍。用药不足、用药过度和用药不当仍然是治疗依从性差的最常见原因。平均40%-60%的COPD患者坚持规定的治疗方案，使用定量吸入器的患者中只有十分之一能正确执行所有基本步骤。治疗依从性是多因素的，涉及患者和初级保健提供者。患者指导对COPD患者吸入器依从性和急救药物使用的影响似乎与哮喘患者报告的良好结果不一致。虽然使用联合吸入器可能有助于坚持用药并提高疗效，但药物经济学因素可能会影响患者对设备和治疗方案的选择。患者的健康信念、经历和行为在药物治疗依从性中起着重要作用。本文综述了与COPD患者药物依从性相关的重要方面，并确定了一些依从性差的预测因素。
