Medication nonadherence and misuse among people with COPD — primarily caused by affordability and a lack of knowledge about medications — leads to increased exacerbations and faster lung decline. This observation was detailed in two papers published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation: “The Long-Term Effects of Cost-Related Nonadherence on COPD Outcomes and Progression in the COPDGene Study Cohort,” and “Determinants of Medication Nonadherence Among Diverse Adults With Chronic Obstructive Pulmonary Disease.”
According to a news release, in the first study, researchers examined a group of 2,521 participants from the COPD Genetic Epidemiology (COPDGene) study who completed social and economic surveys. Cost-related nonadherence was reported in 16.2% of those participants. They reported either not filling a prescription or taking less medication because of expense or lack of adequate insurance coverage. Of those, 93.5% had some form of insurance coverage.
The study found that those who experienced cost-related nonadherence had a quicker decline in their lung function, more frequent exacerbations and a higher burden of symptoms.
“There are a variety of factors that can cause medication nonadherence,” said Rajat Suri, MD, MS, of the Division of Pulmonary, Critical Care and Sleep Medicine at University of California San Diego and lead author of the study. “Many COPD treatments are brand-name inhalers with high out-of-pocket costs.”
Dr. Suri said that broader policy changes are needed to make medications more affordable.
In the other study, researchers conducted interviews with a small cohort of participants from a single academic medical center in Chicago. Of the 17 participants, nearly half reported not taking their medications as prescribed or using their inhalers incorrectly. They cited forgetfulness, physical limitations, limited understanding of how to use inhalers, difficulty accessing care, stigma and cost as barriers.
“Medication nonadherence is common, but the reasons behind it are highly individual,” said Stephanie LaBedz, MD, of the Division of Pulmonary, Critical Care, Sleep and Allergy at University of Illinois Chicago and lead author of the second study. “Physicians need to understand the full range of barriers their patients face so they can provide better education and connect them with support to ensure medications are used correctly.”
