Table 2 Factors that influence treatment adherence in chronic obstructive pulmonary disease (COPD)
FactorInfluence on adherenceReference
Regimen↓ ↓Farmer 1999,21 Sacket 1976,36 Rand 2005,35 Rapoff 200616
Lengthier and more complicated
Long term
Not have medication direct effect
AdministrationGarcia-Aymerich 2000,40 James 1985,38 Tashkin 199534
CostHughes 2004,19 Soumerai 199143
Inability to pay or reduce access
Adverse effectsCol 199042
Old ageRand 199528
Comorbidity including anxiety and depressionCully 2006,46 Hughes 2004,19 Morris 199286
Cognitive defectIncalzi 199744
Difficulty readingZuccollo 198545
Perception of the disease↓ ↑DiMatteo,12 Rapoff 200616
Lack of regular symptom
Affect daily activities and anticipate problem
Perception or social supportTashkin 199534
Stable family life and caregiver
Health care provider
Type of physicianLau 199648
Type of care and service↑ ↑Tashkin 199534
Continuity of care follow-up and written supervision
Written instruction
Self-management with positive reinforcementTurner 1995,15 Dunbar 197952
  • *Polypharmacy has not always proven to be associated with decreased adherence.

  • †Older age may be associated with greater number of comorbid conditions, cognitive defect and difficulty reading, which reduces adherence.