Your Ally in COPD Adherence

April 2026

Despite the disease’s seriousness, COPD stands out as one of the chronic diseases with the most troublesome patient adherence patterns. A recent systematic review finds that in the U.S., three in ten patients are not obtaining enough medication to take it correctly.¹ That research defines adherence as obtaining enough medication to take it correctly 80% of the time. Non-adherence rises to nearly four out of ten patients among the subgroup of patients using long-acting muscarinic antagonists. How serious is 80% adherence? In the same meta-analysis, the non-adherent group demonstrated a 40% greater risk of exacerbations overall, a 56% greater risk of moderate exacerbations, and a 32% greater risk of severe exacerbations.

Of course, primary medication adherence only tells part of the story. Dosing adherence and inhaler technique will add to the primary non-adherence. Older research finds that technique errors often develop over time and that patients are largely not aware of their inhaler technique errors.² That research focused on patients over age 70, and more than half showed signs of at least mild cognitive impairment during their structured interviews. However, in current research by Jacqueline O’Toole, John Hopkins University School of Medicine, et al. patient frustration with the availability of inhaler technique support emerges as a theme.³ 

O’Toole et al. conducted structured interviews to help clinicians gain a deeper understanding of the COPD medication adherence challenge. Patient-reported sources of non-adherence fell into three main categories: (1) gaps in understanding, (2) forgetfulness, and (3) cost navigation. In each of these domains, Ideal Home Care has services designed to improve medication adherence. When elderly patients are homebound, changes in medication or signs of possible non-adherence can justify a home health episode with Medicare paying 100%. Please refer to Ideal Home Care as your ally in medication adherence.

Gaps in Understanding: Patients complained about not being sure about inhaler techniques, especially when more than one model had been prescribed. Ideal Home Care schedules nurses to visit your patients at home, repeatedly, with visits often lasting 30 minutes each. A relaxed pace in the comforting home environment, with follow-up visits to verify successful adherence, can reinforce the teaching that has occurred in the exam room. Ideal nurses can also recruit and train family caregivers to help ensure proper inhaler technique.

Forgetfulness: Patients also reported difficulty with forgetfulness. This was especially true with second, mid-day doses. They reported that logs and visual cues had proven effective strategies. Ideal Home Care nurses routinely help patients implement such strategies. Access to the home and ample time to learn about a patient’s daily routine facilitate the implementation of effective memory strategies. Something as simple as taping a note to the coffee pot can work for some patients. Other patients may respond to programming recurring alarms into their phones or recruiting family caregivers to call each day.

Cost Navigation: Patients cited cost as a reason for primary non-adherence, underdosing, increasing dosages, non-standard sourcing, and other problematic patterns. While receiving samples from doctors was a positive theme, other patients confessed not reporting cost concerns to doctors. Ideal Home Care nurses can help identify economic barriers, report such to doctors, and work on strategies with your patient to help overcome those barriers. Nurses can help patients apply to pharmaceutical companies for cost waivers. Ideal nurses may additionally explore a patient’s other health costs, possibly finding underutilized coverages for other costs, potentially freeing budget for COPD medication adherence. 

Effectiveness: It is well established that weekly COPD educational visits spread over two months improve self-reported quality of life, decrease hospitalizations 27%, and decrease emergency department visits 21%.^4,5 Exercise training at home improves exercise tolerance, dyspnea scores, and quality of life, and in-home exercise training reduces the number of subsequent exacerbations.^6,7 Therapists can also teach energy conservation techniques that improve independence at home.

Please offer Ideal Home Care to Your Patients.      

References

1. Vauterin D, Van Vaerenbergh F, Grymonprez M, Vanoverschelde A, Lahousse L. Medication adherence to inhalation therapy and the risk of COPD exacerbations: a systematic review with meta-analysis. BMJ Open Respiratory Research. 2024 Sep 19;11(1).
2. Barrons R, Pegram A, Borries A. Inhaler device selection: special considerations in elderly patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm. 2011; 68 (13): 1221-1232.
3. O’Toole J, Krishnan M, Riekert K, Eakin MN. Understanding barriers to and strategies for medication adherence in COPD: a qualitative study. BMC Pulmonary Medicine. 2022 Mar 19;22(1):98.
4. Bourbeau J; Julien M, Maltais F, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003; 163 (5): 585-91.
5. Gadoury M, Schwartzman K, Rouleau M. et al. Self-management reduces both short- and long-term hospitalisation in COPD. Eur Respir J. 2005; 26 (5): 853-7.
6. Salman G, Mosier M, Beasley B, et al. Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials. J Gen Intern Med. 2003: 18 (3): 213-21.
7. Murphy N, Bell C, Costello R. Extending a home from hospital care programme for COPD exacerbations to include pulmonary rehabilitation. Respir Med. 2005; 99(10): 1297-302.