Division of Allergy, Helsinki University Central Hospital, Skin and Allergy Hospital, PO Box 160, Helskinki, Hus 00029, Finland.
Respir Med. 2013 Oct;107(10):1481-90. doi: 10.1016/j.rmed.2013.04.005. Epub 2013 May 3.
Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues.
哮喘和慢性阻塞性肺疾病（COPD）药物治疗的依从性差会对疾病控制和治疗成本产生不利影响。不依从的原因涉及患者的知识/教育、吸入装置的便利性和满意度、年龄、不良反应和药物费用。考虑到哮喘在年轻人中的发病率不断上升，以及青少年的不依从率高于儿童和成年人，年龄是一个特别值得关注的问题。哮喘和 COPD 吸入药物治疗的依从性与临床疗效呈正相关，大多数成人、青少年和儿童的研究均表明，症状控制和肺功能得到改善。吸入装置的满意度也与改善的依从性和临床结果以及降低成本呈正相关。良好的依从性可显著降低医疗保健利用率；然而，一般医疗保健相关成本和生产力损失往往仅在病情更严重的患者中得到弥补，而在哮喘或 COPD 病情较轻的患者中则不然。不依从与更高的医疗保健利用率和成本以及降低的健康相关生活质量相关，并且在个人、社会和经济层面仍然是一个问题。需要进一步开发措施来提高依从性，以充分解决这些问题。
