A prospective study to evaluate the medication adherence in COPD patients in a teritiary care centre

 Corresponding author: Acsah Oommen. Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. A prospective study to evaluate the medication adherence in COPD patients in a teritiary care centre Acsah Oommen 1, *, A Abhi ¹, Blessy Ann Rajeev ¹, Alfet Raju Anthraper ², Chitra C Nair ³ and Beena P ⁴ 1 Pharm D Intern, KVM College of Pharmacy, Cherthala, Kerala, India. 2 Associate Professor, Department of Pharmacy Practice, Cherthala, Kerala, India. 3 Professor and HOD, Department of Pharmacy Practice, Cherthala, Kerala, India. 4 Principal, KVM College of Pharmacy, Cherthala, Kerala, India. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 561-567 Publication history: Received on 13 December 2024; revised on 23 January 2025; accepted on 26 January 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.21.1.0089 Abstract BACKGROUND: The third greatest cause of mortality globally, chronic obstructive pulmonary disease (COPD) affects approximately 390 million individuals. For patients with COPD, medication adherence is essential to increasing quality of life, lowering hospitalizations, exacerbations, and medical expenses. Reduced quality of life, exacerbations, and the advancement of the disease can result from noncompliance with medication, including bronchodilators and inhaled corticosteroids. Finding adherence obstacles such as socioeconomic limitations, adverse effects, or a lack of education might help direct actions to increase compliance. METHOD: At baseline, we used a standardized adherence scale to evaluate medication adherence in 100 COPD patients. Patient information leaflets outlining the significance of medications and methods for overcoming typical obstacles were distributed in an effort to increase adherence. The efficiency of the instructional materials was tested by reassessing adherence after two months. RESULTS: Medication adherence at baseline was 4.51±1.78, but at follow-up, it improved to 6.20±1.83 (t=7.214, p<0.001), a statistically significant change. CONCLUSION: At first, the majority of patients had low to medium adherence; 39 patients had medium adherence and 61 patients had low adherence. Adherence improved after the intervention, and at follow-up, 23 patients showed high adherence. This change illustrates how well patient counseling and educational techniques work to increase COPD patients’ adherence to their medication. Keywords: COPD; Medication Adherence; Exacerbation; Quality of Life 1. Introduction A progressive respiratory condition marked by irreversible airflow restriction, chronic obstructive pulmonary disorder (COPD) is mostly brought on by tobacco smoking, environmental factors, and genetic susceptibility. By limiting their physical, emotional, and social well-being, COPD severely lowers patients quality of life (QoL), affecting millions of people worldwide (1). Despite the fact that medication adherence is a critical component of therapeutic results, patients with COPD continue to have inadequate adherence rates, which frequently result in worsening of their condition and a lower quality of life(2). World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 561-567 562 The primary objective of this study is to evaluate medication adherence among COPD patients. Effective treatment of Chronic Obstructive Pulmonary Disease (COPD) depends on medication adherence. It guarantees improved symptom management, lessens the frequency and intensity of flare-ups, and delays the course of the illness. Adherence lowers hospitalization rates and allows patients to carry out everyday tasks, which greatly enhances quality of life (QoL). Using medications correctly also reduces complications by managing common co morbidities like diabetes and hypertension (3). Counseling and patient education is essential for removing obstacles to adherence, like complicated regimens or forgetting. Enhancing adherence is a key component of comprehensive disease management since it can help healthcare systems lower costs and improve outcomes for people with COPD(4). According to the hypothesis, people with COPD who take their prescriptions as directed have better symptom control, fewer acute episodes, a higher quality of life, and a lower need for medical interventions including emergency room visits and hospital stays (5). Evidence showing consistent adherence to treatment regimens reduces disease progression and improves general health status, whereas non-adherence to regimens exacerbates COPD symptoms, served as the basis for the development of this theory(6). This work is significant because it fills in the knowledge vacuum about how adherence affects the management of COPD and offers insights into individualized patient care. It emphasizes the necessity of patient counseling and other interventions to improve patient outcomes, lower healthcare costs, and increase adherence. The results are intended to guide clinical procedures and advance knowledge of chronic illness treatment techniques (6). 2. Materials and methods The study was a prospective, conducted at a tertiary care hospital on 100 COPD patients for a period of six months. The inclusion criteria are patients with COPD in OPD, above 18 years of age. Patients with other co morbid conditions, polypharmacy, and patients of all gender were included in the study. Patients admitted with acute exacerbation of COPD or respiratory failure, patients who are bedridden and pregnant women were excluded. Adherence to medication regimens in COPD patients were evaluated by direct interaction with patients and caregiver. Patient counseling was provided to individual patients to educate about compliance to medication. The data were entered into Microsoft Excel Spreadsheet and Statistical analysis was performed by IBM SPSS 22.0. After obtaining permission from the IEC, study began with data collection. Case records were retrospectively and prospectively reviewed for demographic data, clinical presentations, investigations, management and prognosis. 3. Results and discussion Table 1 frequency and percentage distribution of sample according to age in years Age (in years) Frequency Percentage (%) 30-40 1 1 41-50 7 7 51-60 15 15 61-70 39 39 71-80 27 27 >80 11 11 The study reveals that COPD predominantly affects older individuals, with the highest prevalence observed in the 61– 70-year age group. World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 561-567 563 Table 2 frequency and percentage distribution of samples according to gender GENDER FREQUENCY (n=100) Percentage (%) Male 52 52 Female 48 48 The data shows that COPD is more common in men, with 52% of patients being male. This suggests that men are at a higher risk for COPD when compared to women’s. Table 3 frequency and percentage distribution of sample according to symptom on admission SYMPTOM ON ADMISSION FREQUENCY(n=205) PERCENTAGE (%) Shortness of breath 91 44.39 Cough 62 30.24 Sputum 19 9.26 Fever 12 5.85 Wheezing 8 3.90 Chest pain 4 1.95 Body pain 3 1.46 Headache 2 0.97 Sputum with blood 2 0.97 Throat pain 1 0.48 Low appetite 1 0.48 Our study reveals that the most common symptom on admission among COPD patients are shortness of breath, cough, sputum production and fever. These symptoms are indicative of respiratory distress and infection. Table 4 frequency and percentage distribution of sample according to comorbidity of patients Comorbidity of patients Frequency(n=143) Percentage (%) Hypertension 47 32.86 Diabetes mellitus 37 25.87 Dyslipidemia 20 13.98 Coronary artery disease 17 11.88 Hypothyroidism 7 4.89 Chronic kidney disease 3 2.09 Tuberculosis 2 1.39 Benign prostate hyperplasia 2 1.39 Transient ischemic attack 1 0.699 Non-hodgkin’s lymphoma 1 0.699 Parkinson’s disease 1 0.699 Addison’s disease 1 0.699 Tachycardia 1 0.699 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 561-567 564 Migraine 1 0.699 Stroke 1 0.699 Fatty liver 1 0.699 Our study highlights hypertension (32.86%), diabetes mellitus (25.87%), and dyslipidemia (13.98%) as prevalent co morbidities among COPD patients, potentially impacting the medication adherence. Table 5 frequency and percentage distribution of sample according to polypharmacy Polypharmacy Frequency(n=100) Percentage (%) Present 44 44 Absent 56 56 Figure 1 The distribution of sample according to polypharmacy The data illustrates that 44% of the 100 patients in our study are experiencing polypharmacy, suggesting that medication adherence may be a significant consideration in COPD management. Table 6 frequency and percentage of distribution of sample according to medication adherence [n=100] Level of adherence Baseline Follow-up Frequency(n=100) Percentage (%) Frequency(n=100) Percentage (%) Low 61 61.0 25 25.0 Medium 39 39.0 52 52.0 High - - 23 23.0 World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 561-567 565 Figure 2 The distribution of sample according to level of medication adherence Compared to the baseline, there is noticeable progress in medication adherence among the patients, with more individuals transitioning to moderate and high adherence categories. This improvement can be attributed to the effectiveness of patient counseling interventions. Table 7 mean, standard deviation, mean difference, t value and p value of medication adherence score during baseline and follow-up [n=100] Time Mean Standard deviation Mean difference t value (paired t test) p value Baseline 4.51 1.78 1.69 7.214 <0.001*** Follow-up 6.20 1.83 *** Significant at 0.001 level Figure 3 The mean, standard deviation, mean difference, t value and p value of medication adherence score during baseline and follow-up A comparison of the Medication Adherence Scale baseline and follow-up mean scores for COPD patients highlights significant insights. Initially, the mean score was 4.51, indicating lower medication adherence levels among the patients. However, after receiving patient counselling interventions, the mean score surged to 6.20 upon subsequent evaluation, indicating a marked improvement in medication adherence over time. This underscores the effectiveness of patient World Journal of Biology Pharmacy and Health Sciences, 2025, 21(01), 561-567 566 counselling in enhancing medication adherence among COPD patients, ultimately leading to better treatment outcomes and improved disease management. 4. Limitations Limitations of the Study include • It was a single-centre study, reducing the applicability to other geographic regions or Healthcare settings. • Uncontrolled confounding variables, such as psychological and socioeconomic factors, • May have influenced the results. • The follow-up period was short, limiting observation of long-term effects. • There may have been selection bias in patient enrollment, affecting the study’s outcomes. • In many cases, essential data of patients were missing (such as , past Medical and medication history). 5. Conclusion The results from our study revealed a significant improved medication adherence among COPD patients. When the mean (Medication Adherence Scale) score changes from 4.51 to 6.2, it indicates an improvement in medication adherence by rendering patient counseling within the population being assessed. When individuals adhere more closely to their medication regimens, they are more likely to manage their condition effectively, leading to better health outcomes and an enhanced quality of life. Therefore, in this case, improved medication adherence seems to correlate with improved health-related quality of life. Compliance with ethical standards Acknowledgments We take this opportunity to express our deep sense of gratitude and respectful regards to Dr. Subin E B MBBS MD, Pulmonologist, SH Medical Centre, Kottayam for their immense support, encouragement and credible ideas which have been great contributors in completion of this thesis. We are also thankful to the Management, Nursing Staff and all other Staffs of SH Medical Centre, Kottayam, for their immense support. We sincerely express our gratitude and respect to Mr. Manu K Joseph who helped us a lot in the statistics section. Disclosure of conflict of interest No conflict of interest to be disclosed. Statement of ethical approval The study was approved by the Institutional Ethics Committee Statement of informed consent Informed consent was obtained from all individual participants included in the study. References [1] Petty TL. The history of COPD. International journal of chronic obstructive pulmonary disease. 2006 Jan 1;1(1):314. [2] Han MK, Dransfield MT, Martinez FJ. Chronic obstructive pulmonary disease: diagnosis and staging. Waltham (MA): Wolters Kluwer. [Google Scholar]. 2023. 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