RETRACTED: Determinants of self-reported adherence to inhaler therapy in patients with chronic obstructive pulmonary disease

  • Ilaria Aredano Department of Medical Sciences, University of Turin, Italy.
  • Francesca de Blasio Department of Medical Sciences, University of Turin, Italy.
  • Paola Berchialla Department of Clinical and Biological Sciences, University of Turin, Italy.
  • Luisa Brussino Department of Medical Sciences, University of Turin, Italy.
  • Caterina Bucca | Department of Medical Sciences, University of Turin, Italy.
  • Paolo Solidoro S.C. Pneumologia U, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy.


Background: Adherence to therapy is crucial for COPD patients, since non-adherence leads to worse quality of life, increased health-care expenditure and poor clinical outcome. The aim of this study was to identify the main determinants of suboptimal adherence to therapy in a cohort of COPD patients. Methods: General information (age, BMI, smoking, comorbidities, education, life style), lung function, exacerbations, symptoms and COPD treatment were collected. Adherence to therapy was assessed by self-reported 4-item Morisky Medication Adherence Scale (MMAS-4), and was related to anthropometric, socio/economic and health status data, obtained by questionnaires (COPD Assessment Test, CAT; Treatment Satisfaction Questionnaire, HRQoL; Katz Index of Independence of Daily Living Activities, Lawton Instrumental Activities of Daily Living Scale). Results: 136 COPD patients were studied (age 72±8 yrs; 73.5% men; BMI 28.5±7.4 kg/m2; FEV1 53.5±19.0 % predicted). Nearly half of the patients (46.3%) had suboptimal adherence to therapy (score >0) and, as compared to those with optimal adherence, had higher prevalence of women and coronary artery disease, heavier smoking history and worse CCQ overall score. The results of multivariate analysis showed that the determinants of suboptimal adherence were female sex (OR 4.339, 95%CI 1.509-12.474, p=0.006), amount of pack-years smoked (OR 1.947, 95%CI 1.141-3.323, p=0.015), higher CCQ overall score (OR 3.318, 95%CI 1.050-9.892, p=0.049) and higher education (OR 2.758, 95%CI 1.083-7.022, p=0.033). Adherence was better in patients assuming triple inhaler therapy. Conclusions: Suboptimal adherence is frequent among COPD patients, particularly in women, heavy smokers and subjects with high educational level. Interventions to improve adherence should be especially addressed to patients with these characteristics.



PlumX Metrics


Download data is not yet available.


Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J,et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017;195:557-82. DOI:

Mathers CD, Loncar D. Projections of Global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442. DOI:

Cazzola M, Tashkin DP. Combination of formoterol and tiotropium in the treatment of COPD: effects on lung function. COPD 2009;6:404-15. DOI:

O'Donnell DE, Laveneziana P. The clinical importance of dynamic lung hyperinflation in COPD. COPD 2006;3:219-32. DOI:

Kaplan RM, Ries AL. Quality of life as an outcome measure in pulmonary diseases. J Cardiopulm Rehabil 2005;25:321-31. DOI:

Rosen OZ, Fridman R, Rosen BT, Shane R, Pevnick JM. Medication adherence as a predictor of 30-day hospital readmissions. Patient Prefer Adherence 2017;11:801-10. DOI:

Sanduzzi A, Balbo P, Candoli P, Catapano GA, Contini P, Mattei A, et al. COPD: adherence to therapy. Multidiscip Respir Med 2014;9:60. DOI:

Cushen B, Sulaiman I, Greene G, MacHale E, Mokoka M, Reilly RB, et al. The clinical impact of different adherence behaviors in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2018;197:1630-3. DOI:

Dekhuijzen R, Lavorini F, Usmani OS, van Boven JFM. Addressing the impact and unmet needs of nonadherence in asthma and chronic obstructive pulmonary disease: Where do we go from here? J Allergy Clin Immunol Pract 2018;6:785-93. DOI:

George J, Kong DC, Thoman R, Stewart K. Factors associated with medication nonadherence in patients with COPD. Chest 2005;128:3198-204. DOI:

Earnest MA. Explaining adherence to supplemental oxygen therapy: the patient's perspective. J Gen Intern Med 2002;17:749-55. DOI:

Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 1990;150:841-5. DOI:

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26:319-38. DOI:

Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347-65. DOI:

Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J 2009;34:648-54. DOI:

van der Molen T, Willemse BW, Schokker S, ten Hacken NH, Postma DS, Juniper EF. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes 2003;1:13. DOI:

Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24:67-74. DOI:

Bharmal M, Payne K, Atkinson MJ, Desrosiers MP, Morisky DE, Gemmen E. Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications. Health Qual Life Outcomes 2009;7:36. DOI:

Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118:622-9. DOI:

Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist 1970;10:20-30. DOI:

Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-86. DOI:

Burnham KP, Anderson DR. Model selection and multimodel inference. Springer, New York; 2002.

Steyerberg EW, Harrell FE Jr, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol 2001;54:774-81. DOI:

Sulaiman I, Cushen B, Greene G, et al. objective assessment of adherence to inhalers by patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2017;195:1333-43. DOI:

Laforest L, Denis F, Van Ganse E, Ritleng C, Saussier C, Passante N, et al. Correlates of adherence to respiratory drugs in COPD patients. Prim Care Respir J 2010;19:148-54. DOI:

Duarte-de-Araujo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: understanding patients' adherence to inhaled medications. Int J Chron Obstruct Pulmon Dis 2018;13:2767-73. DOI:

Di Marco F, Verga M, Reggente M, Maria Casanova F, Santus P, Blasi F, et al. Anxiety and depression in COPD patients: The roles of gender and disease severity. Respir Med 2006;100:1767-74. DOI:

Camp PG, Goring SM. Gender and the diagnosis, management, and surveillance of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007;4:686-91. DOI:

Turner J, Wright E, Mendella L, Anthonisen N. Predictors of patient adherence to long-term home nebulizer therapy for COPD. The IPPB Study Group. Intermittent Positive Pressure Breathing. Chest 1995;108:394-400. DOI:

DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 2004;42:200-9. DOI:

Montes de Oca M, Menezes A, Wehrmeister FC, Lopez Varela MV, Casas A, Ugalde L, et al. Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study. PLoS One 2017;12:e0186777. DOI:

Vanfleteren L, Fabbri LM, Papi A, Petruzzelli S, Celli B. Triple therapy (ICS/LABA/LAMA) in COPD: time for a reappraisal. Int J Chron Obstruct Pulmon Dis 2018;13:3971-81. DOI:

George CF, Peveler RC, Heiliger S, Thompson C. Compliance with tricyclic antidepressants: the value of four different methods of assessment. Br J Clin Pharmacol 2000;50:166-71. DOI:

Erickson SR, Coombs JH, Kirking DM, Azimi AR. Compliance from self-reported versus pharmacy claims data with metered-dose inhalers. Ann Pharmacother 2001;35:997-1003. DOI:

Gao X, Nau DP. Congruence of three self-report measures of medication adherence among HIV patients. Ann Pharmacother 2000;34:1117-22. DOI:

Original Research Articles
COPD, therapy adherence, inhaler therapy, lung function
  • Abstract views: 786

  • PDF: 241
How to Cite
Aredano, I., de Blasio, F., Berchialla, P., Brussino, L., Bucca, C., & Solidoro, P. (2020). <b>RETRACTED:</b&gt; Determinants of self-reported adherence to inhaler therapy in patients with chronic obstructive pulmonary disease. Multidisciplinary Respiratory Medicine, 15.

Most read articles by the same author(s)