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 a new 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, M.D., M.S., 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 another 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, M.D., 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.”

To access current and past issues of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, visit journal.copdfoundation.org.

COPD comprises several conditions, including chronic bronchitis and emphysema, and can be caused by irritants like smoke or pollution and genetics. The disease affects more than 30 million Americans, yet awareness of the disease’s symptoms, methods to reduce risk, and disease management remains poor. Symptoms, which include breathlessness, fatigue, and chronic cough, are primarily treated using inhaled medications.

In a new study, “Prevalence of Critical Errors and Insufficient Peak Inspiratory Flow in Patients Hospitalized With COPD in a Department of General Internal Medicine: A Cross-Sectional Study,” the authors examined how often inhalers were misused by patients hospitalized with COPD over the course of nine months at Fribourg Hospital in Switzerland.

Inhaler misuse was categorized as either a critical error in inhalation technique or insufficient peak inspiratory flow. These errors result in a lesser dose of medication reaching the person’s lungs, which impacts the person’s ability to manage their symptoms and can lead to increased exacerbations.

“Misuse of inhalers is common, and in our study, we found that approximately two-thirds of inhalers were misused,” said Gaël Grandmaison, M.D., an assistant physician in internal medicine at University and Hospital of Fribourg in Fribourg, Switzerland. “If an inhaler was misused, a physiotherapist conducted up to three teaching sessions with the patient. These sessions helped reduce the number of critical errors in inhaler use. However, despite this education, more than one in 10 inhalers continued to be used suboptimally, either due to an inability to generate sufficient inspiratory effort or because the inhaler was unsuitable for the patient’s characteristics. These results highlight the importance of regular therapeutic education, assessing the patient’s ability to generate a sufficient inspiratory effort, and selecting an inhaler suited to the patient’s characteristics.”

In a perspective article, “Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly,” the author discusses the decreased effectiveness of inhaled medications as the result of inhaler misuse (often due to intricacies and multiple steps required to use the inhaler) and the high cost of inhaler-based therapies. The author also highlights several advances in inhaler use, including the ability to combine therapies and to choose the right inhaler based on patient-centered decisions.

“Education is key to increasing the effectiveness of inhaled medications, and many clinicians – and often even the patients themselves – are unaware that patients are having difficulty getting enough medication into their lungs,” said Valerie G. Press, M.D., MPH, an associate professor of medicine at the University of Chicago. “Additional inhaler technique education is needed to ensure patients are using the device correctly, especially when multiple inhaled medications are prescribed. Additional education, supported by the necessary resources, would help ensure patients are receiving optimal treatment and avoiding adverse health outcomes.”

To access current and past issues of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, visit journal.copdfoundation.org.