Hendrychova Tereza, Svoboda Michal, Maly Josef, Vlcek Jiri, Zimcikova Eva, Dvorak Tomas, Zatloukal Jaromir, Volakova Eva, Plutinsky Marek, Brat Kristian, Popelkova Patrice, Kopecky Michal, Novotna Barbora, Koblizek Vladimir
Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czechia.
Institute of Biostatistics and Analyses, Ltd. Spin-off Company of the Masaryk University, Brno, Czechia.
Front Pharmacol. 2022 Aug 12;13:860270. doi: 10.3389/fphar.2022.860270. eCollection 2022.
Adherence to inhaled medication constitutes a major problem in patients with chronic obstructive pulmonary disease (COPD) globally. However, large studies evaluating adherence in its entirety and capturing a large variety of potentially associated factors are still lacking. To study both elementary types of adherence to chronic inhaled COPD medication in "real-life" COPD patients and to assess relationships with a wide-ranging spectrum of clinical parameters. Data from the Czech Multicentre Research Database (CMRD) of COPD, an observational prospective study, were used. Overall adherence (OA) was evaluated with Morisky Medication Adherence Scale (©MMAS-4) and adherence to an application technique (A-ApplT) with the Five Steps Assessment. Mann-Whitney test, Spearman's correlation, and logistic regression were used to explore relationships between variables. Data of 546 participants (69.6% of all patients from the CMRD) were analyzed. Two-thirds self-reported optimal OA, but only less than one-third demonstrated A-ApplT without any error. OA did not correlate with A-ApplT. Next, better OA was associated with higher education, a higher number of inhalers, a lower rate of exacerbations, poorer lung function, higher degree of upper respiratory tract symptoms (SNOT-22), absence of depressive symptoms, ex-smoking status, regular mouthwash after inhaled corticosteroids (ICS), and flu vaccination. By contrast, better A-ApplT was associated with a lower number of inhalers, better lung function, and regular mouthwash after ICS. Independent predictors of nonoptimal OA included lower degree of education, absence of flu vaccination, anemia, depression, and peptic ulcer history, whereas independent predictors of lower A-ApplT were lower education, absence of regular mouthwash after ICS, and higher COPD Assessment Test score. Parameters associated with OA and A-ApplT differ, and those associated with both adherence domains are sometimes associated inversely. Based on this finding, we understand these as two separate constructs with an overlap.
在全球慢性阻塞性肺疾病（COPD）患者中，吸入药物的依从性是一个主要问题。然而，目前仍缺乏全面评估依从性并涵盖多种潜在相关因素的大型研究。为了研究“现实生活”中COPD患者对慢性吸入性COPD药物的两种基本依从类型，并评估其与广泛临床参数之间的关系，我们使用了来自捷克COPD多中心研究数据库（CMRD）的观察性前瞻性研究数据。总体依从性（OA）采用Morisky药物依从性量表（©MMAS - 4）进行评估，应用技术依从性（A - ApplT）采用五步评估法进行评估。使用Mann - Whitney检验、Spearman相关性分析和逻辑回归来探索变量之间的关系。对546名参与者（占CMRD所有患者的69.6%）的数据进行了分析。三分之二的患者自我报告OA最佳，但只有不到三分之一的患者在A - ApplT方面没有任何错误。OA与A - ApplT不相关。接下来，更好的OA与更高的教育程度、更多的吸入器数量、更低的急性加重率、更差的肺功能、更高程度的上呼吸道症状（SNOT - 22）、无抑郁症状、已戒烟状态、吸入糖皮质激素（ICS）后定期漱口以及流感疫苗接种有关。相比之下，更好的A - ApplT与更少的吸入器数量、更好的肺功能以及ICS后定期漱口有关。非最佳OA的独立预测因素包括较低的教育程度、未接种流感疫苗、贫血、抑郁和消化性溃疡病史，而较低A - ApplT的独立预测因素是较低的教育程度、ICS后未定期漱口以及较高的COPD评估测试得分。与OA和A - ApplT相关的参数不同，且与两个依从领域相关的参数有时呈负相关。基于这一发现，我们将其理解为两个有重叠的独立结构。
