Self-reported reasons for treatment nonadherence in chronic obstructive pulmonary disease (COPD) patients: a 24-week prospective cohort study in China.

BACKGROUND

Adherence to medication plays an important role in the control of disease progression and treatment costs for patients with chronic obstructive pulmonary disease (COPD). Existing studies are mostly retrospective studies based on local medical insurance databases and prescription records and therefore cannot analyze or determine the causes of poor adherence in COPD patients.

METHODS

This is a prospective study that enrolled 1,223 COPD patients, including 929 newly diagnosed patients and 294 previously diagnosed patients. Telephone follow-up was conducted to administer a questionnaire on treatment adherence and collect detailed information on the prescriptions and the actual use of medications for COPD. The follow-up period was 24 weeks.

RESULTS

COPD patients had adherence rates of 74.65%, 49.63%, and 33.61% at 4-, 12-, and 24-week telephone follow-ups, respectively. Cox regression showed that women, newly diagnosed patients, patients with a mild Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, and patients with fewer routes of administration had poorer adherence. According to the subgroup analysis of the diagnostic status, the overall adherence of the newly diagnosed patients was poorer than that of the previously diagnosed patients. Among the causes of nonadherence, drug stoppage after remission (27.2%) was the most common cause, followed by economic factors (21.5%) and poor efficacy (21.1%).

CONCLUSIONS

This is the first study focusing on the adherence behavior of newly diagnosed COPD patients and the first large-scale clinical study on the Chinese population. Overall, sex, diagnostic status (newly diagnosed and previously diagnosed), GOLD stage, and routes of administration were the four major factors that affected the adherence of COPD patients.