Patient Preference and Adherence (Sep 2018)
Patients with underuse or overuse of inhaled corticosteroids have different perceptions and beliefs regarding COPD and inhaled medication
Abstract
Kirsten Koehorst-ter Huurne,1 Marjolein Brusse-Keizer,2 Paul van der Valk,1 Kris Movig,3 Job van der Palen,2,4 Christina Bode5 1Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands; 2Department of Epidemiology, Medisch Spectrum Twente, Enschede, the Netherlands; 3Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, the Netherlands; 4Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands; 5Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands Background: Therapy adherence in COPD is crucial for treating symptoms, preventing exacerbations, and related complications. To achieve optimal adherence, it is important to recognize and understand a nonadherent patient. Objective: To study perceptions and beliefs regarding COPD and inhaled medication in COPD patients with poor adherence. Methods: Twenty patients (10 underuse, 10 overuse) were interviewed in semistructured in-depth interviews, about mental and physical health, illness perceptions, knowledge regarding COPD, and experience with, knowledge of, and acceptance of COPD medication and inhalation devices. Results: A majority of patients did not fully accept their disease, showed little disease knowledge, and many revealed signs of depressive mood and severe fatigue. Overusers reported more grief about decreased participation in daily life and were more frustrated in general. Underusers claimed using less medication because they felt well, did not want to use too much medication, and used their inhalation devices too long. Overusers reported medication “dependency”; they tended to catastrophize when being without medication and discarded inhalation devices too early because they feared running out of medication. Conclusion: Overusers and underusers showed a different pattern in perceptions and beliefs regarding inhaled medication and COPD. Practical implications: It is important to understand the reasons for under- and overuse. Is it related to practical issues regarding knowledge or is it influenced by beliefs and/or anxiety concerning COPD or medication? These issues need to be addressed for improving adherence. Keywords: COPD, adherence, illness perceptions, medication beliefs, in-depth interviews
