Affordability and education are preventing COPD patients from remaining adherent to their prescribed pharmacologies.
RT’s Three Key Takeaways:
Cost Drives Nonadherence and Worse Outcomes: Two studies found that affordability issues led 16% of surveyed COPD patients to skip or reduce medications, which was associated with faster lung function decline, more exacerbations, and higher symptom burden.
Knowledge and Access Barriers Persist: Interviews with patients at University of Illinois Chicago revealed that nearly half reported improper or inconsistent inhaler use due to forgetfulness, limited understanding, physical limitations, stigma, and difficulty accessing care.
Policy and Education Needed: Researchers from University of California San Diego emphasized that high out-of-pocket costs for brand-name inhalers and individualized patient barriers require broader policy solutions and improved clinician education to reduce preventable COPD complications.
Medication nonadherence among people with COPD is a result of affordability and lack of knowledge about medications, among other factors, and leads to increased exacerbations and faster lung function decline, according to two new studies [1] [2] published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.
COPD, which includes emphysema and chronic bronchitis, affects more than 30 million Americans and is the fourth leading cause of death worldwide. It can be caused by genetics and irritants like smoke or pollution.
Inhaled medicines can help improve symptoms and reduce exacerbations. However, studies have shown that approximately 43% to 58.7% of people do not take their medication as prescribed by their physician, leading to higher rates of hospital admissions and increased mortality.
In the first study, researchers examined a group of 2,521 participants from the COPD Genetic Epidemiology (COPDGene®) study, who completed social and economic surveys. Cost-related nonadherence was reported in 16.2% (408) of those participants. These individuals had either not filled a prescription or taken less medication because of expense or lack of coverage. Of those, 93.5% had some form of health insurance.
Study results showed that those who experienced cost-related nonadherence had a quicker decline in their lung function, more frequent exacerbations, and a higher symptom burden.
“There are a variety of factors that can cause medication nonadherence. For people with COPD and other chronic lung diseases, cost is a significant factor. Many COPD treatments are brand-name inhalers with high out-of-pocket costs,” said Rajat Suri, MD, MS, of the Division of Pulmonary, Critical Care, and Sleep Medicine at University of California San Diego and lead author of the study. “Broader policy changes are needed to make these medications more affordable. The two respiratory inhalers undergoing negotiation in the second round of the Inflation Reduction Act could help reduce cost-related nonadherence.”
In a second new study, researchers conducted interviews with a small cohort of participants from a single academic medical center in Chicago. Of the 17 participants, nearly half reported not taking their medications as prescribed or using their inhalers incorrectly. Participants cited forgetfulness, physical limitations, limited understanding of how or when to use inhalers, difficulty accessing care, stigma, and cost as barriers.
“Medication nonadherence is common, but the reasons behind it are highly individual,” said Stephanie L. LaBedz, MD, of the Division of Pulmonary, Critical Care, Sleep, and Allergy at University of Illinois Chicago and lead author of the study. “Physicians need to understand the full range of barriers their patients face so they can provide better education and connect them with support to ensure medications are used correctly.”