**Treatment**

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**14** 

**Adherence to Therapy in Chronic** 

Chronic obstructive pulmonary disease (COPD) is a major public health problem for both industrialised and developing countries (Viegi et al., 2001). The prevalence of COPD is increasing worldwide, resulting in a substantial economic burden, including direct and

Non-adherence in COPD is common and poses a significant barrier to optimal disease management. According to the World Health Organization (WHO), adherence to long-term therapies averages only 50% (WHO, 2003). Patient adherence in chronic diseases can result in poor health outcomes and increased health-care expenditures (WHO, 2003). Discontinuation of COPD therapy contributes to increasing the frequency of exacerbations, the number of hospitalisations and the mortality rate (Bourbeau & Bartlett, 2008; Regueiro et

Clinical trials may overestimate the level of adherence to medication regimens. Adherence rates in clinical trials have been expected to be approximately 70%–90% among patients with COPD (Kesten et al., 2000; van Grunsven et al., 2000; Rand et al., 1995). In clinical practice, these rates are only in the range of 20%–60% (Agh et al., 2011; Bosley et al., 1994; Dolce et al., 1991; Krigsman et al., 2007a). This difference reflects the fact that patient adherence may be an important explanatory factor of the difference between the efficacy of treatment under experimental conditions and the real-world effectiveness of the treatment

Non-adherence in patients with COPD has a number of causes, including factors related to the characteristics of the patient, the disease, the therapies and the health-care provider– patient relationship (Baiardini et al., 2009; Restrepo et al., 2008; WHO, 2003). Physicians should understand the factors and the strategies that facilitate adherence to improve the

The goals of this chapter are as follows: to highlight the importance of adherence in the management of COPD; to introduce the reader to the concepts of adherence, compliance and persistence; to address different methods of measuring adherence; to identify factors related to adherence; and to emphasise strategies to enhance adherence in patients with

**1. Introduction** 

al., 1998; Vestbo et al., 2011).

(Revicki & Frank, 1999).

effectiveness of the therapy.

COPD.

indirect health-care costs (Chapman et al., 2006).

**Obstructive Pulmonary Disease** 

Tamas Agh and Agnes Meszaros

*Semmelweis University* 

*Hungary* 
