Validation of the 'Test of the Adherence to Inhalers' (TAI) for Asthma and COPD Patients

J Aerosol Med Pulm Drug Deliv. 2016 Apr;29(2):142-52. doi: 10.1089/jamp.2015.1212. Epub 2015 Jul 31.


Background: To validate the 'Test of Adherence to Inhalers' (TAI), a 12-item questionnaire designed to assess the adherence to inhalers in patients with COPD or asthma.

Methods: A total of 1009 patients with asthma or COPD participated in a cross-sectional multicenter study. Patients with electronic adherence ≥80% were defined as adherents. Construct validity, internal validity, and criterion validity were evaluated. Self-reported adherence was compared with the Morisky-Green questionnaire.

Results: Factor analysis study demonstrated two factors, factor 1 was coincident with TAI patient domain (items 1 to 10) and factor 2 with TAI health-care professional domain (items 11 and 12). The Cronbach's alpha was 0.860 and the test-retest reliability 0.883. TAI scores correlated with electronic adherence (ρ=0.293, p=0.01). According to the best cut-off for 10 items (score 50, area under the ROC curve 0.7), 569 (62.5%) patients were classified as non-adherents. The non-adherence behavior pattern was: erratic 527 (57.9%), deliberate 375 (41.2%), and unwitting 242 (26.6%) patients. As compared to Morisky-Green test, TAI showed better psychometric properties.

Conclusions: The TAI is a reliable and homogeneous questionnaire to identify easily non-adherence and to classify from a clinical perspective the barriers related to the use of inhalers in asthma and COPD.

Keywords: anti-asthmatic agents, administration and dosage; inhalers; medication adherence; medication non-adherence; pulmonary disease, chronic obstructive, drug therapy; questionnaires; validation studies.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Administration, Inhalation
  • Adult
  • Aged
  • Area Under Curve
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Bronchodilator Agents / administration & dosage*
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Lung / drug effects*
  • Lung / physiopathology
  • Male
  • Medication Adherence*
  • Middle Aged
  • Nebulizers and Vaporizers*
  • Pilot Projects
  • Psychometrics
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • ROC Curve
  • Reproducibility of Results
  • Spain
  • Surveys and Questionnaires*


  • Bronchodilator Agents