**4.1 Factors related to the characteristics of COPD**

COPD is a progressive chronic disease. Adequate cooperation with COPD therapy can improve the patient's quality of life and reduce the frequency of exacerbations but cannot fully control the disease symptoms. A progressive decline in lung function is often interpreted by patients as the medication not helping, so they stop following the recommendations (Chambers et al., 1999). In contrast, a lack of clinical symptoms could also be a reason for suboptimal adherence (DiMatteo, 2004). As implied above, the negative impact of COPD severity or lung function on a patient's adherence is not obvious. Prior studies have shown that disease severity or the post-bronchodilator forced expiratory volume in one second (FEV1) percentage may be either not (Agh et al., 2011) or negatively (Turner et al., 1995) related to adherence. The pathologic characteristics of COPD influence

Adherence to Therapy in Chronic Obstructive Pulmonary Disease 283

Patient cooperation is better with oral medication than with inhaled drugs (James et al., 1985; Tashkin et al., 1991). Adherence with inhaled drugs may be compromised by inadequate inhaler technique (Garcia-Aymerich et al., 2000; Shrestha et al., 1996). Furthermore, better adherence with oral theophylline can also be due to the simplicity of the

Other factors, such as adverse effects and medication costs, are also important. Medication cost is one of the greatest barriers to achieving adequate adherence (Cramer et al., 2007, Jung et al., 2009). Side effects or concerns about side effects from medications can reduce adherence as well (Dolce et al., 1991; Rand et al., 1995). For example, patients with COPD often confuse the side effects of ICS with those of anabolic steroids, which may decrease

Effective COPD management requires a good relationship between health-care providers and the patients. Quality of communication is related to adherence. Adherent patients report better overall communication with their providers (Blais et al., 2004). Education during the consultation and providing more information about the therapy may improve adherence (Raynor, 1992), as it reduces the risk of forgetting the providers' recommendations and the likelihood of misunderstandings between providers and patients. Previous studies suggest that immediately after the consultation, patients recall less than

The type of caregiver also influences adherence. Medication adherence may increase if the prescribing physician is a specialist instead of a general practitioner (Lau et al., 1996). Furthermore, periodic visits, closer follow-up and hospitalisation may also have increasing

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



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


**4.4 Factors related to the characteristics of the health-care provider–patient** 

50% of the information conveyed by their provider (DiMatteo, 1991).

effects on patient cooperation (Breekveldt-Postma et al., 2007).

**5. Adherence enhancing interventions** 

Petrilla and Benner (Petrilla & Benner, 2003).




convenience;


clinicians and other health professionals;



dosing regimens (Kelloway et al., 1995).

their cooperation willingness (Boulet, 1998).

**relationship** 

adherence to non-drug therapy as well; a poor COPD prognosis has been identified as one of the most demotivating factors to quit smoking (George et al., 2006b).
