Korean J Adult Nurs.  2015 Dec;27(6):665-672. 10.7475/kjan.2015.27.6.665.

Inhaler Competency and Medication Adherence in Older Adults and Adults with Obstructive Lung Disease

• Kim SJ
• Shin YS

• KMID: 2221720
• DOI: http://doi.org/10.7475/kjan.2015.27.6.665

Abstract

PURPOSE
The aims of current study were to assess the inhaler competency and medication adherence, and to identify association of inhaler competency with medication adherence in patients with obstructive lung disease.
METHODS
We did a secondary analysis of the Hanyang Obstructive Pulmonary Evaluation data in a single institution from June 2014 to April 2015 after an approval of Institutional Review Board. A total of 150 patients with asthma or chronic obstructive lung disease participated in the study. Inhaler competency was evaluated accuracy in each step for using metered dose inhaler. Medication adherence was calculated using actually dispensed doses based on the prescribed inhaler doses.
RESULTS
Older adults (> or =65) had lower competency in using inhaler (66.7 vs 83.3, z=-4.52, p<.001) and poorer medication adherence (67.7 vs 91.8, chi2=14.06, p<.001) than adults (<65). Inhaler competency was associated with medication adherence (p=.26, p=.001). Surprisingly, more than 50% of patients were current smokers.
CONCLUSION
Inhaler competency and medication adherence were lower in older adults with obstructive lung disease than those in adult-age patients. Therefore, an individual education program for older patients should be developed to improve the rates of proper use of inhalers. Nursing management for obstructive lung disease should focus on developing behavioral intervention strategies for smoking cessation.

MeSH Terms

Adult*
Asthma
Education
Ethics Committees, Research
Humans
Lung Diseases, Obstructive*
Medication Adherence*
Metered Dose Inhalers
Nebulizers and Vaporizers*
Nursing
Prescription Drug Misuse
Pulmonary Disease, Chronic Obstructive
Smoking Cessation

Reference

1. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach [Internet]. Geneva: WHO Press;2007. cited 2015 September 3. Available from: http://apps.who.int/iris/bitstream/10665/43776/1/9789241563468_eng.pdf.

2. Korea Centers for Disease Control and Prevention. Prevalence of chronic obstructive pulmonary disease among adults over 40 years old in Korea, 2009-2013 [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2015. cited 2015 May 10. Available from: http://www.cdc.go.kr/CDC/info/CdcKrInfo0301.jsp?menuIds=HOME001-MNU1132-MNU1138-MNU0037-MNU1380&cid=62279.

3. Ministry of Health and Welfare. Korea health statistics 2012: Korea national health and nutrition examination survey. National Survey Report. Sejong: Division of Health Policy Ministry of Health and Welfare;2013. KNHANES V-3.

4. Korea Centers for Disease Control and Prevention. 2013 Korea nationalhealth and nutrition examination survey VI. National Survey Report. Sejong: Ministry of Health and Welfare;2014. cited 2015 April 20. Available from: http://www.cdc.go.kr/CDC/intro/CdcKrIntro0201.jsp?menuIds=HOME001-MNU1154-MNU0005-MNU0011&cid=28314.

5. Development Committee of Korea Guideline for Asthma. Korean guideline for asthma[Internet]. Seoul: The Korean Academy of Asthma, Allergy and Clinical Immunology, The Korean Academy of Pediatric Allergy and Respiratory Disease, National Strategic Coordinating Center for Clinical Research;2015. cited 2015 September 2. Available from:http://www.allergy.or.kr/board/view.html?code=notice&num=1378.

6. Makela MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respiratory Medicine. 2013; 107(10):1481–1490. DOI: 10.1016/j.rmed.2013.04.005.

7. Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management, and prevention: a guide for health care professionals [Internet]. Online: Global Initiative for Chronic Obstructive Lung Disease;2015. cited 2015 April 12. Available from:http://www.goldcopd.org/uploads/users/files/GOLD_Pocket_2015_Feb18.pdf.

8. Restrepo RD, Alvarez MT, Wittnebel LD, Sorenson H, Wettstein R, Vines DL, et al. Medication adherence issues in patients treated for COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2008; 3(3):371–384.

9. Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respiratory Medicine. 2011; 105(6):930–938. DOI: 10.1016/j.rmed.2011.01.005.

10. Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherenceand therisk of severe asthma exacerbations: a systematic review. European Respiratory Journal. 2015; 45(2):396–407. DOI: 10.1183/09031936.00075614.

11. Baddar S, Jayakrishnan B, Al-Rawas OA. Asthma control: importance of compliance and inhaler technique assessments. Journal of Asthma. 2014; 51(4):429–434. DOI: 10.3109/02770903.2013.871558.

12. Goris S, Tasci S, Elmali F. The effects of training on inhaler technique and quality of life in patients with COPD. Journal of Aerosol Medicine and Pulmonary Drug Delivery. 2013; 26(6):336–344. DOI: 10.1089/jamp.2012.1017.

13. Park S, Cho Y, Ji H, Lee J, Kim Y, Lee T, et al. Evaluation of the inhalation performance in patients with asthma. Korean Journal of Asthma Allergy Clinical Immunology. 2003; 23(4):781–787.

14. Federman AD, Wolf MS, Sofianou A, Martynenko M, O'Connor R, Halm EA, et al. Self-management behaviors in older adults with asthma: associations with health literacy. Journal of the American Geriatrics Society. 2014; 62(5):872–879. DOI: 10.1111/jgs.12797.

15. Jeong J, Chang Y, Kim C, Kim T, Kim S, Kwon Y, et al. Assessment of techniques for using inhalers in primary care physicians. Asthma and Allergy. 2011; 31(2):116–122.

16. O'Conor R, Wolf MS, Smith SG, Martynenko M, Vicencio DP, Sano M, et al. Health literacy, cognitive function, proper use, and adherence to inhaled asthma controller medications among older adults with asthma. Chest. 2015; 147(5):1307–1315. DOI: 10.1378/chest.14-0914.

17. Santos Pde M, D'Oliveira A Jr, Noblat Lde A, Machado AS, Noblat AC, Cruz AA. Predictors of adherence to treatment in patients with severe asthma treated at a referral center in Bahia, Brazil. Jornal Brasileiro de Pneumologia. 2008; 34(12):995–1002.

18. Lurslurchachai L, Krauskopf K, Roy A, Halm EA, Leventhal H, Wisnivesky JP. Metered dose inhaler technique among innercity asthmatics and its association with asthma medication adherence. Clinical Respiratory Journal. 2014; 8(4):397–403. DOI: 10.1111/crj.12084.

19. Fink JB, Rubin BK. Problems with inhaler use: a call for improved clinician and patient education. Respiratory Care. 2005; 50(10):1360–1374.

20. Bender BG, Pedan A, Varasteh LT. Adherence and persistence with fluticasone propionate/salmeterol combination therapy. Journal of Allergy and Clinical Immunology. 2006; 118(4):899–904.

21. Krigsman K, Nilsson JL, Ring L. Refill adherence for patients with asthma and COPD: comparison of a pharmacy record database with manually collected repeat prescriptions. Pharmacoepidemiology and Drug Safety. 2007; 16(4):441–448.

22. Broder MS, Chang EY, Kamath T, Sapra S. Poor disease control among insured users of high-dose combination therapy for asthma. Allergy and Asthma Proceedings. 2010; 31(1):60–67. DOI: 10.2500/aap.2010.31.3302.

23. Bae YJ, Kim TB, Jee YK, Park HW, Chang YS, Cho SH, et al. Severe asthma patients in Korea over estimate their adherence to inhaled corticosteroids. Journal of Asthma. 2009; 46(6):591–595. DOI: 10.1080/02770900902980908.

24. Tashkin DP. Smoking cessation in chronic obstructive pulmonary disease. Seminars in Respiratory and Critical Care Medicine. 2015; 36(4):491–507. DOI: 10.1055/s-0035-1555610.

25. Tavakol M, Dennick R. Making sense of Cronbach's alpha. International Journal of Medical Education. 2011; 2(1):53–55. DOI: 10.5116/ijme.4dfb.8dfd.