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Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

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ABSTRACT

OBJECTIVE

We tested the hypothesis that use of and adherence to maintenance medication is low among in-dividuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD.

DESIGN AND PARTICIPANTS

We identified 5,812 individuals with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1–4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, long-acting anti-cholinergics, or long-acting beta2-agonists was identified in a nationwide registry. Use of medication was defined as medication dispensed during a one-year period , and adherence was calculated from dosages available in one year.

KEY RESULTS

Use of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists varied from 2 % to 61 % (p < 0.001, test for trend), long-acting anti-cholinergics varied from 0.4 % to 36 % (p < 0.001), and long-acting beta2-agonists varied from 0.3 % to 11 % (p < 0.001. Among utilizers of these medications, adherence varied from 29 % to 56 % (p < 0.001, test for trend) across GOLD 1–4 for fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, from 51 % to 68 % (p = 0.11) for long-acting anti-cholinergics, and from 25 to 62 % (p = 0.01) for long-acting beta2-agonists.

CONCLUSIONS

Use of and adherence to maintenance medication for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

ICS/LABA:

Fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists

LAMA:

Long-acting anti-cholinergics

LABA:

Long-acting beta2-agonists

FEV1 :

Forced expiratory volume in one second

FVC:

forced vital capacity

CGPS:

Copenhagen General Population Study

GOLD:

Global initiative for Obstructive Lung Disease

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Funders

The present analyses were sponsored by an unrestricted grant from GlaxoSmithKline (grant: EPI 115882 – EUPharmaLocal), the Capital Region of Copenhagen, the Danish Heart Foundation, the Danish Lung Foundation, the Velux Foundation, and Herlev University Hospital. The study sponsors had no role or any type of influence on study design, collection of data, analysis, interpretation, writing process, or submission decision.

Conflict of Interest

J.V. has received honoraria from GlaxoSmithKline, Almirall, AstraZeneca, Boehringer Ingelheim, Novartis, and Takeda for consulting and for presenting at meetings and symposia. P.L. has received honoraria from GlaxoSmithKline and other pharmaceutical companies for consulting and teaching and for presenting at meetings and symposia. J.H. has participated in research projects funded by Novartis, Pfizer, MSD, Nycomed, and ALK-Abelló, with grants paid to the institution where he was employed, and has received fees for teaching or consulting from Nycomed, Pfizer, Novartis, AstraZeneca, and other pharmaceutical companies. T.S.I., J.L.M., M.D., and B.G.N. have nothing to declare.

Author Contributions

J.V., B.G.N., and P.L. obtained the funding. J.V., P.L, and T.S.I. wrote the protocol. M.D. and B.G.N. collected the data. J.L.M. and T.S.I. performed the statistical analysis. T.S.I., J.L.M., P.L., J.H., and J.V. analyzed and interpreted the data. T.S.I. wrote the manuscript. J.V., J.L.M., P.L., M.D., J.H., and B.G.N. revised the manuscript. T.S.I. and J.L.M. had full access to all of the data in the study and take responsibility for the integrity and accuracy of the data analysis and for the submission.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense C, Denmark

    Truls S. Ingebrigtsen M.D. & Jørgen Vestbo M.D., D.M.Sc.

  2. The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark

    Truls S. Ingebrigtsen M.D., Jacob L. Marott Statistician., Børge G. Nordestgaard M.D., D.M.Sc. & Peter Lange M.D., D.M.Sc.

  3. The Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark

    Truls S. Ingebrigtsen M.D., Børge G. Nordestgaard M.D., D.M.Sc. & Peter Lange M.D., D.M.Sc.

  4. Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark

    Børge G. Nordestgaard M.D., D.M.Sc.

  5. Respiratory Section, Hvidovre Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark

    Peter Lange M.D., D.M.Sc.

  6. Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

    Peter Lange M.D., D.M.Sc.

  7. Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark

    Jesper Hallas M.D., D.M.Sc.

  8. Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark

    Morten Dahl M.D., D.M.Sc.

  9. Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK

    Jørgen Vestbo M.D., D.M.Sc.

Authors
  1. Truls S. Ingebrigtsen M.D.
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  2. Jacob L. Marott Statistician.
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  3. Børge G. Nordestgaard M.D., D.M.Sc.
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  4. Peter Lange M.D., D.M.Sc.
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  5. Jesper Hallas M.D., D.M.Sc.
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  6. Morten Dahl M.D., D.M.Sc.
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  7. Jørgen Vestbo M.D., D.M.Sc.
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Corresponding author

Correspondence to Truls S. Ingebrigtsen M.D..

Additional information

What is the major question?

What are the patterns of use and adherence to maintenance medications according to severity of chronic obstructive pulmonary disease (COPD)?

What is important?

Individuals with COPD in the general population do not get the full benefits of maintenance medications, as these are often not used, and when they are used, adherence is low, even in severe and very severe COPD.

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Ingebrigtsen, T.S., Marott, J.L., Nordestgaard, B.G. et al. Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population. J GEN INTERN MED 30, 51–59 (2015). https://doi.org/10.1007/s11606-014-3029-0

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  • DOI: https://doi.org/10.1007/s11606-014-3029-0

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