Introduction
The desired control levels cannot be achieved in patients with obstructive lung diseases despite the frequent use of inhaled corticosteroid and long-acting beta agonist combination (ICS / LABA). Insufficient adherence, incorrect inhaler technique, and refractory disease are the most important causes of uncontrolled obstructive lung diseases. Strict patient adherence to inhaler therapies in asthma and chronic obstructive lung disease (COPD), together with correct application of the inhaler technique, are the two most critical issues in obtaining the desired treatment results [1,2]. However, studies clearly show that adherence with inhaler treatments is insufficient in patients with asthma and COPD [3,4].
In a study conducted with difficult asthmatics, it was found that low adherence was more common in women and was associated with repeated hospitalizations as well as frequent use of nebulized bronchodilator medication [3]. A retrospective cohort study examining 11,708 COPD patients in China showed that using ICS / LABA combination maintenance therapy with high adherence levels resulted in 34.8% less hospitalizations due to exacerbations compared to those using this treatment low adherence [4].
Non-adherence is associated with many poor clinical outcomes, and non-adherence determination is crucial for optimal disease management. In the study of Murphy et al. patients with poor ICS adherence had lower post-bronchodilator forced expiratory volume in 1 second (FEV1) values and higher sputum eosinophils compared to those with adequate ICS adherence. There was no statistically significant difference between these two groups in terms of age, gender, ethnicity, smoking history, and salvage oral prednisolone therapy. However, it has been shown that patients with poor adherence with ICS treatment are mostly ventilated [5]. The findings revealed by Murphy et al. leave us face to face with the important reality of correct assessment of adherence in asthmatics. Because if the adherence is not evaluated correctly, it can lead to unnecessary additions of drugs to the treatment of patients and even to treatment with biological agents that are very popular today.
Today there is no method that accurately evaluates adherence [6]. However, rational studies are planned on this subject and it is obvious that there will be a very important paradigm change in the very near future [7]. Most research focuses on drug adherence. However, there is no uniformity in the terminology used to describe adherence. In the study of Vrijens et al., it was determined through a literature review that more than ten different terms had been used to describe appropriate use of medication [8].
Adherence, actually, encompasses a range of health-related behaviors that go beyond taking prescription drugs. World Health Organization (WHO) defines adherence as the extent to which the patient follows medical instructions . However the organization emphasizes some very important points related to this definition. First, the termmedical is considered insufficient to describe the various interventions used to treat chronic diseases. Second, the terminstructions implies that the patient is a passive recipient who can receive expert advice as opposed to an active collaborator in the treatment process. Moreover, in its report WHO underlines that adherence is a set of behaviors. Seeking medical help, filling prescriptions, taking medications properly, attending follow-up appointments, self-management of the disease, smoking, unhealthy diet, and physical activity are all examples of therapeutic behavior [9]. A more robust evidence-based approach is needed to assess adherence. If a systematic approach and standardization for measuring and reporting compliance can be developed, patient follow-up can be made better and the value and generalizability of research can increase [10].
In this study, we aimed to ask the patients with obstructive lung disease and their relatives about the medication adherence of the patients and to evaluate the consistency of the information they provide. In addition, we aimed to compare the demographic, smoking-related, and clinical characteristics of patients who stated that they were adherent and non-adherent to inhaler therapy.