Predictors of adherence to inhaled medications among Veterans with COPD

J Gen Intern Med. 2012 Nov;27(11):1506-12. doi: 10.1007/s11606-012-2130-5. Epub 2012 Jul 11.


Background: Factors contributing to medication nonadherence among patients with chronic obstructive pulmonary disease (COPD) are poorly understood.

Objectives: To identify patient characteristics that are predictive of adherence to inhaled medications for COPD and, for patients on multiple inhalers, to assess whether adherence to one medication class was associated with adherence to other medication classes.

Design: Cohort study using data from Veteran Affairs (VA) electronic databases.

Participants: This study included 2,730 patients who underwent pulmonary function testing between 2003 and 2007 at VA facilities in the Northwestern United States, and who met criteria for COPD.

Main measures: We used pharmacy records to estimate adherence to inhaled corticosteroids (ICS), ipratropium bromide (IP), and long-acting beta-agonists (LABA) over two consecutive six month periods. We defined patients as adherent if they had refilled medications to have 80 % of drug available over the time period. We also collected information on their demographics, behavioral habits, COPD severity, and comorbidities.

Key results: Adherence to medications was poor, with 19.8 % adherent to ICS, 30.6 % adherent to LABA, and 25.6 % adherent to IP. Predictors of adherence to inhaled therapies were highly variable and dependent on the medication being examined. In adjusted analysis, being adherent to a medication at baseline was the strongest predictor of future adherence to that same medication [(Odds ratio, 95 % confidence interval) ICS: 4.78 (3.21-7.11); LABA: 6.56 (3.89-11.04); IP: 13.96 (9.88-19.72)], [corrected] but did not reliably predict adherence to other classes of medications. [corrected].

Conclusions: Among patients with COPD, past adherence to one class of inhaled medication strongly predicted future adherence to the same class of medication, but only weakly predicted adherence to other classes of medication.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use*
  • Adrenergic beta-2 Receptor Agonists / administration & dosage
  • Adrenergic beta-2 Receptor Agonists / therapeutic use*
  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Ipratropium / administration & dosage
  • Ipratropium / therapeutic use*
  • Male
  • Medication Adherence / psychology*
  • Middle Aged
  • Northwestern United States
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Veterans*


  • Adrenal Cortex Hormones
  • Adrenergic beta-2 Receptor Agonists
  • Ipratropium