Adherence to inhaled therapy, mortality and hospital admission in COPD

J Vestbo; J A Anderson; P M A Calverley; B Celli; G T Ferguson; C Jenkins; K Knobil; L R Willits; J C Yates; P W Jones

doi:10.1136/thx.2009.113662

Adherence to inhaled therapy, mortality and hospital admission in COPD

J Vestbo, J A Anderson, P M A Calverley, B Celli, G T Ferguson, C Jenkins, K Knobil, L R Willits, J C Yates, P W Jones

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

427 Citationer (Scopus)

Abstract

Udgivelsesdato: 2009-Nov

Originalsprog	Engelsk
Tidsskrift	Thorax
Vol/bind	64
Udgave nummer	11
Sider (fra-til)	939-43
Antal sider	4
ISSN	0040-6376
DOI	https://doi.org/10.1136/thx.2009.113662 https://doi.org/10.1136/thx.2009.113662
Status	Udgivet - 2009

Bibliografisk note

Keywords: Administration, Inhalation; Adult; Aged; Aged, 80 and over; Albuterol; Androstadienes; Bronchodilator Agents; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Epidemiologic Methods; Female; Hospitalization; Humans; Male; Medication Adherence; Middle Aged; Pulmonary Disease, Chronic Obstructive

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Citationsformater

@article{d05c2100aab711df928f000ea68e967b,

title = "Adherence to inhaled therapy, mortality and hospital admission in COPD",

abstract = "BACKGROUND: Little is known about adherence to inhaled medication in chronic obstructive pulmonary disease (COPD) and the impact on mortality and morbidity. METHODS: Data on drug adherence from a randomised double-blind trial comparing inhaled salmeterol 50 microg + fluticasone propionate 500 microg twice daily with placebo and each drug individually in 6112 patients with moderate to severe COPD over 3 years in the TORCH study were used. All-cause mortality and exacerbations leading to hospital admission were primary and secondary end points. The study of adherence was not specified a priori as an ancillary study. RESULTS: Of the 4880 patients (79.8%) with good adherence defined as >80% use of study medication, 11.3% died compared with 26.4% of the 1232 patients (20.2%) with poor adherence. The annual rates of hospital admission for exacerbations were 0.15 and 0.27, respectively. The association between adherence and mortality remained unchanged and statistically significant after adjusting for other factors related to prognosis (hazard ratio 0.40 (95% CI 0.35 to 0.46), p<0.001). The association was even stronger when analysing on-treatment deaths only. Similarly, the association between adherence and hospital admission remained unchanged and significant in a multivariate analysis (rate ratio 0.58 (95% CI 0.44 to 0.73, p<0.001). The association between increased adherence and improved mortality and reduction in hospital admission was independent of study treatment. The effect of treatment was more pronounced in patients with good adherence than in those with poor adherence. CONCLUSION: Adherence to inhaled medication is significantly associated with reduced risk of death and admission to hospital due to exacerbations in COPD. Further research is needed to understand these strong associations.",

author = "J Vestbo and Anderson, {J A} and Calverley, {P M A} and B Celli and Ferguson, {G T} and C Jenkins and K Knobil and Willits, {L R} and Yates, {J C} and Jones, {P W}",

note = "Keywords: Administration, Inhalation; Adult; Aged; Aged, 80 and over; Albuterol; Androstadienes; Bronchodilator Agents; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Epidemiologic Methods; Female; Hospitalization; Humans; Male; Medication Adherence; Middle Aged; Pulmonary Disease, Chronic Obstructive",

year = "2009",

doi = "10.1136/thx.2009.113662",

language = "English",

volume = "64",

pages = "939--43",

journal = "Thorax",

issn = "0040-6376",

publisher = "B M J Group",

number = "11",

}

TY - JOUR

T1 - Adherence to inhaled therapy, mortality and hospital admission in COPD

AU - Vestbo, J

AU - Anderson, J A

AU - Calverley, P M A

AU - Celli, B

AU - Ferguson, G T

AU - Jenkins, C

AU - Knobil, K

AU - Willits, L R

AU - Yates, J C

AU - Jones, P W

N1 - Keywords: Administration, Inhalation; Adult; Aged; Aged, 80 and over; Albuterol; Androstadienes; Bronchodilator Agents; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Epidemiologic Methods; Female; Hospitalization; Humans; Male; Medication Adherence; Middle Aged; Pulmonary Disease, Chronic Obstructive

PY - 2009

Y1 - 2009

N2 - BACKGROUND: Little is known about adherence to inhaled medication in chronic obstructive pulmonary disease (COPD) and the impact on mortality and morbidity. METHODS: Data on drug adherence from a randomised double-blind trial comparing inhaled salmeterol 50 microg + fluticasone propionate 500 microg twice daily with placebo and each drug individually in 6112 patients with moderate to severe COPD over 3 years in the TORCH study were used. All-cause mortality and exacerbations leading to hospital admission were primary and secondary end points. The study of adherence was not specified a priori as an ancillary study. RESULTS: Of the 4880 patients (79.8%) with good adherence defined as >80% use of study medication, 11.3% died compared with 26.4% of the 1232 patients (20.2%) with poor adherence. The annual rates of hospital admission for exacerbations were 0.15 and 0.27, respectively. The association between adherence and mortality remained unchanged and statistically significant after adjusting for other factors related to prognosis (hazard ratio 0.40 (95% CI 0.35 to 0.46), p<0.001). The association was even stronger when analysing on-treatment deaths only. Similarly, the association between adherence and hospital admission remained unchanged and significant in a multivariate analysis (rate ratio 0.58 (95% CI 0.44 to 0.73, p<0.001). The association between increased adherence and improved mortality and reduction in hospital admission was independent of study treatment. The effect of treatment was more pronounced in patients with good adherence than in those with poor adherence. CONCLUSION: Adherence to inhaled medication is significantly associated with reduced risk of death and admission to hospital due to exacerbations in COPD. Further research is needed to understand these strong associations.

AB - BACKGROUND: Little is known about adherence to inhaled medication in chronic obstructive pulmonary disease (COPD) and the impact on mortality and morbidity. METHODS: Data on drug adherence from a randomised double-blind trial comparing inhaled salmeterol 50 microg + fluticasone propionate 500 microg twice daily with placebo and each drug individually in 6112 patients with moderate to severe COPD over 3 years in the TORCH study were used. All-cause mortality and exacerbations leading to hospital admission were primary and secondary end points. The study of adherence was not specified a priori as an ancillary study. RESULTS: Of the 4880 patients (79.8%) with good adherence defined as >80% use of study medication, 11.3% died compared with 26.4% of the 1232 patients (20.2%) with poor adherence. The annual rates of hospital admission for exacerbations were 0.15 and 0.27, respectively. The association between adherence and mortality remained unchanged and statistically significant after adjusting for other factors related to prognosis (hazard ratio 0.40 (95% CI 0.35 to 0.46), p<0.001). The association was even stronger when analysing on-treatment deaths only. Similarly, the association between adherence and hospital admission remained unchanged and significant in a multivariate analysis (rate ratio 0.58 (95% CI 0.44 to 0.73, p<0.001). The association between increased adherence and improved mortality and reduction in hospital admission was independent of study treatment. The effect of treatment was more pronounced in patients with good adherence than in those with poor adherence. CONCLUSION: Adherence to inhaled medication is significantly associated with reduced risk of death and admission to hospital due to exacerbations in COPD. Further research is needed to understand these strong associations.

U2 - 10.1136/thx.2009.113662

DO - 10.1136/thx.2009.113662

M3 - Journal article

C2 - 19703830

SN - 0040-6376

VL - 64

SP - 939

EP - 943

JO - Thorax

JF - Thorax

IS - 11

ER -