Is therapy adherence to inhaled corticosteroids related to hospitalization, pneumonia or mortality in COPD?

Objective: To study the relationship between therapy adherence to inhaled corticosteroids and morbidity and mortality in COPD. Methods: Therapy adherence of 627 patients was recorded from pharmacy records over 3 years. It was expressed as percentage and deemed good at 75–125%, suboptimal 50-75%, and poor 125%. The relationship between adherence and morbidity and mortality was analyzed by Cox Regression. Inhaled steroids include fluticasone, budesonide, beclometasone, ciclesonide, all as a single component or combined with a sympathomimetic. If a patient used >1inhaled steroid, therapy adherence percentages were combined to an average adherence. Results: Suboptimal adherence to inhaled steroids is related to hospital admission. Compared to optimal use there is a 1.4 increased risk for hospital admission (table 1). Combining therapy adherence to an average adherence when patients use >1 inhaled steroid may distort our results. However, analyzing therapy adherence of patients using only one inhaled steroid (n= 508) gave similar results. The Hazard ratio for hospital admission with suboptimal adherence is 1.44 (95%CI: 1.03-2.03). Conclusion: Only suboptimal adherence to inhaled corticosteroids is associated with an increased risk of hospital admission.