Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
Research Unit of Respiratory Disease, Central South University, Changsha, China.
J Gen Intern Med. 2024 Jan;39(1):69-76. doi: 10.1007/s11606-023-08378-y. Epub 2023 Aug 24.
Adherence to inhaled medications is key to chronic obstructive pulmonary disease (COPD) control and management.
To assess errors and adherence to inhalation therapy in COPD patients, and identify potential factors associated with poor adherence.
This cross-sectional study was conducted from October 1, 2022, to November 30, 2022, in 24 hospital outpatient departments in different cities of Hunan Province, China. Adherence to inhaled medications was measured using the 10-item Test of Adherence Inventory, and the results were expressed using both descriptive and inferential statistics.
A total of 2218 clinically confirmed adult COPD patients completed the questionnaires, and 1423 patients with more than a 3-month history of inhalation therapy were analyzed. This study found that 61.3% of patients made one or more use errors. Not holding the breath after inhalation or holding the breath for less than 3 s had the highest reporting rate (30.7%). A considerable proportion of patients (66.6%) demonstrated suboptimal adherence to inhaled medications. Patients who resided in rural areas (OR 1.45, 95% CI 1.12-1.88), used dual therapy (OR 1.47, 95% CI 1.05-2.05), and exhibited common use errors (OR 3.02, 95% CI 2.39-3.82) were more likely to present suboptimal adherence. Patients with CAT (Chronic Obstructive Pulmonary Disease Assessment Test) score < 10 (OR 0.73, 95% CI 0.56-0.94), a junior high school education and above (OR 0.73, 95% CI 0.57-0.94), and duration of inhaled medication use > 3 years (OR 0.63, 95% CI 0.47-0.83) were associated with better adherence.
Suboptimal adherence to inhaled medications and many inhalation therapy errors were identified among COPD patients. Common use errors in inhaled medications, CAT score, and education background were predictive of and influenced adherence to inhaled medications. It is necessary to strengthen training in Chinese patients about inhaler use and follow-up intensively with patients throughout treatment, especially for patients with risk factors.
遵医嘱使用吸入药物是慢性阻塞性肺疾病（COPD）控制和管理的关键。
评估 COPD 患者在吸入治疗中的错误和依从性，并确定与依从性差相关的潜在因素。
本横断面研究于 2022 年 10 月 1 日至 11 月 30 日在湖南省不同城市的 24 家医院门诊进行。采用 10 项用药依从性测试量表（Test of Adherence Inventory）评估患者的吸入药物依从性，结果采用描述性和推断性统计方法进行分析。
共有 2218 名经临床确诊的成年 COPD 患者完成了问卷，其中 1423 名患者的吸入治疗史超过 3 个月。研究发现，61.3%的患者存在一种或多种使用错误。吸入后不屏气或屏气时间少于 3 秒的报告率最高（30.7%）。相当一部分患者（66.6%）对吸入药物的依从性不理想。居住在农村地区的患者（OR 1.45，95%CI 1.12-1.88）、使用双联治疗（OR 1.47，95%CI 1.05-2.05）和存在常见使用错误（OR 3.02，95%CI 2.39-3.82）的患者更有可能出现依从性不佳。CAT（慢性阻塞性肺疾病评估测试）评分<10 的患者（OR 0.73，95%CI 0.56-0.94）、具有初中及以上文化程度的患者（OR 0.73，95%CI 0.57-0.94）和吸入药物使用时间>3 年的患者（OR 0.63，95%CI 0.47-0.83）依从性更好。
COPD 患者存在吸入药物依从性差和多种吸入治疗错误。常见的吸入药物使用错误、CAT 评分和教育背景是影响患者吸入药物依从性的预测因素。有必要加强对中国患者吸入器使用的培训，并在整个治疗过程中对患者进行密切随访，特别是对有危险因素的患者。
