Kokturk Nurdan, Polatli Mehmet, Oguzulgen I Kivilcim, Saleemi Sarfraz, Al Ghobain Mohammed, Khan Javed, Doble Adam, Tariq Luqman, Aziz Fayaz, El Hasnaoui Abdelkader
Department of Pulmonary Medicine, School of Medicine, Gazi University, Besevler, Turkey.
Department of Pulmonary Medicine, School of Medicine, Adnan Menderes University, Aydin, Turkey.
Int J Chron Obstruct Pulmon Dis. 2018 Apr 27;13:1377-1388. doi: 10.2147/COPD.S150411. eCollection 2018.
BACKGROUND: COPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia. METHODS: An observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity. RESULTS: Four hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 <6). Of those, 74.7% reported high disease impact (CAT >15) compared to 58.4% reporting medium/high adherence (=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; <0.0001). Depression with HADS score 8-10 or >10 was associated with lower adherence (OR 2.50 [95% CI: 1.43-4.39] and 2.43 [95% CI: 1.39-4.25], respectively; =0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33-0.98] and 0.38 [95% CI: 0.15-1.00], respectively; =0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33-0.95]; =0.0314). CONCLUSION: Adherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence.
背景：慢性阻塞性肺疾病（COPD）影响着全球数百万人。治疗依从性差会导致症状加重、发病率和死亡率上升。本研究旨在调查土耳其和沙特阿拉伯COPD治疗的依从性。 方法：对土耳其和沙特阿拉伯的成年COPD患者进行一项观察性横断面研究。通过医生主导的访谈，收集社会人口统计学和疾病史数据，包括使用COPD评估测试（CAT）评估COPD对健康状况的影响；使用欧洲五维健康量表（EQ-5D）评估生活质量；使用医院焦虑抑郁量表（HADS）评估焦虑和抑郁情况。使用8项Morisky药物依从性量表（MMAS-8）测量治疗依从性。多因素逻辑回归分析检查不依从的预测因素以及依从性对症状严重程度的影响。 结果：405例COPD患者参与研究：土耳其199例，沙特阿拉伯206例。总体而言，49.2%的患者报告依从性低（MMAS-8<6）。其中，74.7%的患者报告疾病影响大（CAT>15），而报告中等/高依从性（MMAS-8≥6）的患者为58.4%（P=0.0008）。依从性低的患者报告的平均3级EQ-5D效用值（0.54±0.35）低于中等/高依从性的患者（0.64±0.30；P<0.0001）。HADS评分8-10或>10的抑郁与较低的依从性相关（OR分别为2.50[95%CI：1.43-4.39]和2.43[95%CI：1.39-4.25]；P=0.0008）。与未接受高中教育相比，高中/大学毕业与更好的依从性相关（OR分别为0.57[95%CI：0.33-0.98]和0.38[95%CI：0.15-1.00]；P=0.0310）。在调整年龄、性别和国家后，观察到治疗依从性（MMAS-8评分≥6）与较低的疾病影响（CAT≤15）之间存在显著关联（OR为0.56[95%CI：0.33-0.95]；P=0.0314）。 结论：土耳其和沙特阿拉伯的COPD治疗依从性较差。不依从治疗与更高的疾病影响和生活质量下降相关。抑郁、年龄和教育水平是依从性的独立决定因素。
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