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‘Home Alone’ – Remote monitoring in lung disease
S117 Poor adherence in exacerbating COPD patients: magnitude and related factors at baseline in the MAGNIFY pragmatic trial
  1. AP Dickens1,
  2. DMG Halpin2,
  3. V Carter1,
  4. D Skinner1,
  5. K Beeh3,
  6. J Chalmers4,
  7. A Clark5,
  8. N Hannan6,
  9. A Kaplan7,
  10. K Kostikas8,
  11. H Pinnock9,
  12. N Roche10,
  13. O Usmani11,
  14. JFM van Boven12,
  15. P Mastoridis13,
  16. K Mezzi14,
  17. S Davis15,
  18. E Vijaykumar16,
  19. D Price1
  1. 1Observational and Pragmatic Research Institute, Singapore, Singapore
  2. 2University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
  3. 3Clinical Research, Insaf Respiratory Research Institute, Wiesbaden, Germany
  4. 4Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  5. 5Norwich Medical School, University of East Anglia, East Anglia, UK
  6. 6Research and Innovation at the Priory Gardens Surgery, Dunstable, UK
  7. 7Family Physician Airways Group of Canada, Stouffville, Ontario, Canada
  8. 8Respiratory Medicine Department, University of Ioannina, Ioannina, Greece
  9. 9Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
  10. 10Department of Respiratory Medicine, APHP-Centre University of Paris, Cochin Hospital and Institute UM, Paris, France
  11. 11Faculty of Medicine, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
  12. 12Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, Netherlands
  13. 13Novartis Pharmaceuticals Corporation, New Jersey, USA
  14. 14Novartis Pharma AG, Basel, Switzerland
  15. 15Interface Clinical Services, Leeds, UK
  16. 16Modality Partnership, UK

Abstract

Introduction and Objectives Maintenance inhaled therapies can stabilise COPD symptoms and reduce the risk of exacerbations, but inhaler adherence is often poor. Patients experiencing frequent exacerbations represent a specific high-risk population in need of further intervention. Little data exist regarding inhaled medication adherence amongst exacerbating COPD patients. The MAGNIFY cluster randomised trial is investigating the effect of a technologically-supported adherence package for exacerbating COPD patients in primary care. Using baseline data from this trial, we explore inhaler adherence and compare characteristics of exacerbating COPD patients, stratified by adherence to inhaled maintenance therapy.

Methods Algorithms run on electronic medical records (EMR) of 137 GP practices identified COPD patients aged ≥40 years, with ≥2 moderate/severe exacerbations in the last two years. EMR-based patient adherence was based on the 12 months prior to 1st March 2020, if ever prescribed inhaled maintenance therapy.

Results Of those with available data, 41.2% of COPD patients (10882/26411) had ≥2 moderate/severe exacerbations in the last two years. Almost two thirds (6929/10882, 63.7%) of the patient sample were prescribed triple therapy, with LABA/ICS being the second most common therapy (1699/10882, 15.6%) (table 1). Over a third of patients (4168/10882, 38.3%) were ≤50% adherent on at least one therapy. Patients with ≤50% adherence had more health care contacts in the 12 months prior to 1st March 2022, worse dyspnoea and inhaler technique, and proportionally higher prescriptions for triple therapy. Furthermore, patients on triple therapy were more likely to have ≤50% adherence compared to any other therapy type (43.5% vs 31.4% or lower).

View this table:
Abstract S117 Table 1

Demographic and clinical characteristics of exacerbating COPD patients

Conclusions Poor adherence was common amongst exacerbating COPD patients, and was associated with more health care contacts, and worse respiratory symptoms and inhaler technique. Triple therapy was the most common inhaled maintenance therapy in this patient population, but it also had substantially lower adherence compared to other therapies. Adherence was worse amongst patients on dual and triple therapies, indicating that future adherence support interventions should be targeted at these subgroups. Analyses comparing adherence to open/closed inhaled therapies will be presented at the conference.

https://doi.org/10.1136/thorax-2022-BTSabstracts.123

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