Thorax 63:831-838 doi:10.1136/thx.2007.086041
  • Review

Patient adherence in COPD

  1. J Bourbeau1,
  2. S J Bartlett1,2
  1. 1
    Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, McGill University, Montréal, Québec, Canada
  2. 2
    Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA
  1. Dr J Bourbeau, Montréal Chest Institute, McGill University Health Centre, 3650 St Urbain, Office K1.30, Montréal, Québec H2X 2P4; jean.bourbeau{at}
  • Received 21 June 2007
  • Accepted 16 January 2008


Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients’ perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients’ beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients.


  • Funding: JB is a recipient of the Fraser, Monat and McPherson Award, Faculty de Medicine, McGill University.

  • Competing interests: None.