Review articleAdherence to COPD treatment: Myth and reality

- The level of medication adherence in COPD patients is very low.
- Approaches to assess adherence of COPD are burdened with important limitations.
- Patient views on therapy effectiveness are powerful predictors of reported adherence.
- The physician can affect adherence in COPD with his/her prescription.
- In COPD, adherence to inhalation medication is device-related.

COPD is a chronic disease in which effective management requires long-term adherence to pharmacotherapies but the level of adhesion to the prescribed medications is very low and this has a negative influence on outcomes. There are several approaches to detect non-adherence, such as pharmacy refill methods, electronic monitoring, and self-report measures, but they are all burdened with important limitations. Medication adherence in COPD is multifactorial and is affected by patients (health beliefs, cognitive abilities, self-efficacy, comorbidities, psychological profile, conscientiousness), physicians (method of administration, dosing regimen, polypharmacy, side effects), and society (patient-prescriber relationship, social support, access to medication, device training, follow-up). Patient-health care professional communication, especially that between patient and physician or pharmacist, is central to optimizing patient adherence. However, the most realistic approach is to keep in mind that non-adherence is always possible, indeed, probable.