1 Clinical Research Centre, Beaumont Hospital.
2 Department of Psychology.
Am J Respir Crit Care Med. 2017 May 15;195(10):1333-1343. doi: 10.1164/rccm.201604-0733OC.
Objective adherence to inhaled therapy by patients with chronic obstructive pulmonary disease (COPD) has not been reported.
To objectively quantify adherence to preventer Diskus inhaler therapy by patients with COPD with an electronic audio recording device (INCA).
This was a prospective observational study. On discharge from hospital patients were given a salmeterol/fluticasone inhaler with an INCA device attached. Analysis of this audio quantified the frequency and proficiency of inhaler use.
Patients with COPD (n = 244) were recruited. The mean age was 71 years, mean FEV was 1.3 L, and 59% had evidence of mild/moderate cognitive impairment. By combining time of use, interval between doses, and critical technique errors, thus incorporating both intentional and unintentional nonadherence, a measure "actual adherence" was calculated. Mean actual adherence was 22.6% of that expected if the doses were taken correctly and on time. Six percent had an actual adherence greater than 80%. Hierarchical clustering found three equally sized well-separated clusters corresponding to distinct patterns. Cluster 1 (34%) had low inhaler use and high error rates. Cluster 2 (25%) had high inhaler use and high error rates. Cluster 3 (36%) had overall good adherence. Poor lung function and comorbidities were predictive of poor technique, whereas age and cognition with poor lung function distinguished those with poor adherence and frequent errors in technique.
These data may inform clinicians in understanding why a prescribed inhaler is not effective and to devise strategies to promote adherence in COPD.
慢性阻塞性肺疾病（COPD）患者吸入治疗的客观依从性尚未报道。
使用电子音频记录装置（INCA）客观地量化 COPD 患者预防器 Diskus 吸入器治疗的依从性。
这是一项前瞻性观察研究。患者从医院出院时，会获得一个带有 INCA 装置的沙美特罗/氟替卡松吸入器。对该音频的分析量化了吸入器使用的频率和熟练度。
共招募了 244 名 COPD 患者。平均年龄为 71 岁，平均 FEV1 为 1.3 L，59%有轻度/中度认知障碍的证据。通过结合使用时间、剂量间隔和关键技术错误，从而同时包含有意和无意的不依从性，计算出一个“实际依从性”的度量。如果正确且按时服用剂量，预计的实际依从率为 22.6%。6%的患者实际依从率大于 80%。层次聚类发现了三个大小相等、分离良好的集群，对应于不同的模式。集群 1（34%）吸入器使用率低且错误率高。集群 2（25%）吸入器使用率高且错误率高。集群 3（36%）总体依从性良好。较差的肺功能和合并症与较差的技术相关，而年龄和认知功能与较差的肺功能一起区分了那些依从性差且技术错误频繁的患者。
这些数据可以为临床医生提供信息，了解为什么规定的吸入器无效，并制定策略来促进 COPD 患者的依从性。
