**5. Adherence enhancing interventions**

Strategies for improving patient adherence have to be formulated based on factors related to adherence. Seventy-six adherence interventions were evaluated in the systematic review by Petrilla and Benner (Petrilla & Benner, 2003).

They identified the following main categories of adherence-enhancing interventions:


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Successful adherence-enhancing programs include simplified treatment regimens, facilitation of the physician–patient relationship and patient education methods (Petrilla & Benner, 2003).

While many studies have evaluated strategies to enhance adherence, few of these have focused on COPD. Strategies for improving adherence in COPD include simplifying treatment regimens, improving communication between providers and patients, disease education, optimising inhaler technique, reinforcement and self-management (selfmonitoring of symptoms and medication use).

It may be important to prescribe drugs with a fixed combination and/or a low dosing frequency to enhance adherence to COPD medication. Furthermore, the recommended treatment should fit into the patient's limitations and lifestyle. Because many COPD patients are elderly, with the dual risk of cognitive impairment and complex medication regimens, the use of dosing aids and adherence devices, such as medication lists, dosette boxes and timers, should be promoted.

Health-care providers must help their patients understand the progressive nature of COPD and the goals of the comprehensive treatment regimens. Physicians should actively involve patients in decisions regarding their therapy and give strong weight to their personal preferences and concerns. Periodic monitoring, understanding the patient's beliefs and positive reinforcement could also enhance adherence to therapy (Dunbar et al., 1979).
