Background: COPD is a common disease and the third leading cause of death worldwide. Major symptoms are dyspnea, cough and sputum production. COPD patients can suffer from exacerbations which are acute episodes during which the symptoms and airflow limitation increase. Inhaled bronchodilators and corticosteroids are the main drugs used for maintenance therapy. Adherence in the COPD population is low, which can have an impact on the control of the disease. The test of adherence to inhalers (TAI) questionnaire was recently developed to assess COPD patient’s adherence to inhaled treatments. However, this questionnaire has not yet been rigorously validated in the COPD population. Aims: Our research project aims at determining the factors associated with poor/good adherence by comparing the adherence to various patient, disease and treatment characteristics. The second objective of our study is to assess/validate the TAI more rigorously by comparing the results obtained thanks to the TAI with the drug dispensing data obtained from the referring pharmacist of the patients. Methods: 75 COPD patients were recruited. These patients responded to various questionnaires (including the TAI questionnaire) to enable us to collect data on patient, disease and treatment characteristics. Drug dispensing data were obtained from the referring pharmacists. Analysis: The adherence rate of this study population was high (69% according to the TAI-10 score and 77% according to the drug dispensing data score). Patients were classified into the adherent group or the non-adherent group according to their TAI-10 score and their drug dispensing data score. The TAI classification showed very few significant differences. However, the classification according to the dispensing data showed significant differences that seem to be consistent such as differences concerning the disease severity (p-value = 0.035), FEV1 post-bronchodilator (p-value = 0.029), having inhaled corticosteroids (p-value = 0.020) and having rescue therapy ((p-value = 0.039), … We did not find an association between adherence and exacerbations. The concordance of the 2 adherence scores was evaluated by regression analysis, Kappa hypothesis test and ROC analysis. All analyses (Kappa: 0.0598, r2: 0.0108, ROC AUC: 0.5437) pointed to a bad concordance between the 2 methods for assessing adherence. Conclusion: There was no concordance between the two measures of adherence. Our results suggested that the two tools did not assess the same thing. Classification according to dispensing data did, however, allow us to find consistent differences with the literature. In our analysis we did not find an association between adherence and exacerbations.
|la date de réponse||21 janv. 2021|
|Superviseur||ERIC MARCHAND (Promoteur)|