Introduction
The desired control levels cannot be achieved in patients with
obstructive lung diseases despite the frequent use of inhaled
corticosteroid and long-acting beta agonist combination (ICS / LABA).
Insufficient adherence, incorrect inhaler technique, and refractory
disease are the most important causes of uncontrolled obstructive lung
diseases. Strict patient adherence to inhaler therapies in asthma and
chronic obstructive lung disease (COPD), together with correct
application of the inhaler technique, are the two most critical issues
in obtaining the desired treatment results [1,2]. However, studies
clearly show that adherence with inhaler treatments is insufficient in
patients with asthma and COPD [3,4].
In a study conducted with difficult asthmatics, it was found that low
adherence was more common in women and was associated with repeated
hospitalizations as well as frequent use of nebulized bronchodilator
medication [3]. A retrospective cohort study examining 11,708 COPD
patients in China showed that using ICS / LABA combination maintenance
therapy with high adherence levels resulted in 34.8% less
hospitalizations due to exacerbations compared to those using this
treatment low adherence [4].
Non-adherence is associated with many poor clinical outcomes, and
non-adherence determination is crucial for optimal disease management.
In the study of Murphy et al. patients with poor ICS adherence had lower
post-bronchodilator forced expiratory volume in 1 second
(FEV1) values and higher sputum eosinophils compared to
those with adequate ICS adherence. There was no statistically
significant difference between these two groups in terms of age, gender,
ethnicity, smoking history, and salvage oral prednisolone therapy.
However, it has been shown that patients with poor adherence with ICS
treatment are mostly ventilated [5]. The findings revealed by Murphy
et al. leave us face to face with the important reality of correct
assessment of adherence in asthmatics. Because if the adherence is not
evaluated correctly, it can lead to unnecessary additions of drugs to
the treatment of patients and even to treatment with biological agents
that are very popular today.
Today there is no method that accurately evaluates adherence [6].
However, rational studies are planned on this subject and it is obvious
that there will be a very important paradigm change in the very near
future [7]. Most research focuses on drug adherence. However, there
is no uniformity in the terminology used to describe adherence. In the
study of Vrijens et al., it was determined through a literature review
that more than ten different terms had been used to describe appropriate
use of medication [8].
Adherence, actually, encompasses a range of health-related behaviors
that go beyond taking prescription drugs. World Health Organization
(WHO) defines adherence as the extent to which the patient follows
medical instructions . However the organization emphasizes some very
important points related to this definition. First, the termmedical is considered insufficient to describe the various
interventions used to treat chronic diseases. Second, the terminstructions implies that the patient is a passive recipient who
can receive expert advice as opposed to an active collaborator in the
treatment process. Moreover, in its report WHO underlines that adherence
is a set of behaviors. Seeking medical help, filling prescriptions,
taking medications properly, attending follow-up appointments,
self-management of the disease, smoking, unhealthy diet, and physical
activity are all examples of therapeutic behavior [9]. A more robust
evidence-based approach is needed to assess adherence. If a systematic
approach and standardization for measuring and reporting compliance can
be developed, patient follow-up can be made better and the value and
generalizability of research can increase [10].
In this study, we aimed to ask the patients with obstructive lung
disease and their relatives about the medication adherence of the
patients and to evaluate the consistency of the information they
provide. In addition, we aimed to compare the demographic,
smoking-related, and clinical characteristics of patients who stated
that they were adherent and non-adherent to inhaler therapy.