Koehorst-Ter Huurne Kirsten, Brusse-Keizer Marjolein, van der Valk Paul, Movig Kris, van der Palen Job, Bode Christina
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands,
Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands.
Patient Prefer Adherence. 2018 Sep 12;12:1777-1783. doi: 10.2147/PPA.S167002. eCollection 2018.
Therapy adherence in COPD is crucial for treating symptoms, preventing exacerbations, and related complications. To achieve optimal adherence, it is important to recognize and understand a nonadherent patient.
To study perceptions and beliefs regarding COPD and inhaled medication in COPD patients with poor adherence.
Twenty patients (10 underuse, 10 overuse) were interviewed in semistructured in-depth interviews, about mental and physical health, illness perceptions, knowledge regarding COPD, and experience with, knowledge of, and acceptance of COPD medication and inhalation devices.
A majority of patients did not fully accept their disease, showed little disease knowledge, and many revealed signs of depressive mood and severe fatigue. Overusers reported more grief about decreased participation in daily life and were more frustrated in general. Underusers claimed using less medication because they felt well, did not want to use too much medication, and used their inhalation devices too long. Overusers reported medication "dependency"; they tended to catastrophize when being without medication and discarded inhalation devices too early because they feared running out of medication.
Overusers and underusers showed a different pattern in perceptions and beliefs regarding inhaled medication and COPD.
It is important to understand the reasons for under- and overuse. Is it related to practical issues regarding knowledge or is it influenced by beliefs and/or anxiety concerning COPD or medication? These issues need to be addressed for improving adherence.
慢性阻塞性肺疾病（COPD）的治疗依从性对于缓解症状、预防急性加重及相关并发症至关重要。为实现最佳依从性，识别和了解不依从的患者很重要。
研究依从性差的COPD患者对COPD及吸入药物的认知和信念。
对20例患者（10例用药不足，10例用药过度）进行半结构式深入访谈，内容涉及心理和身体健康、疾病认知、COPD相关知识，以及COPD药物和吸入装置的使用体验、知识和接受程度。
大多数患者未完全接受自身疾病，疾病知识匮乏，许多患者表现出抑郁情绪和严重疲劳的迹象。用药过度者对日常生活参与度下降更为苦恼，总体上更沮丧。用药不足者称用药较少是因为感觉良好，不想使用过多药物，且吸入装置使用时间过长。用药过度者称对药物有“依赖”；他们在未用药时往往会灾难化地看待问题，且过早丢弃吸入装置，因为担心药物用完。
用药过度者和用药不足者在对吸入药物和COPD的认知及信念方面表现出不同模式。
了解用药不足和用药过度的原因很重要。这与知识方面的实际问题有关，还是受对COPD或药物治疗的信念和/或焦虑影响？为提高依从性，需要解决这些问题。
