الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 212 |  |  |
| | | from | 212 | | |
Abstract
Summary
Asthma and COPD represents an important public health challenge and is a major cause of chronic morbidity and mortality throughout the world suggesting that marked increases in interventions be accelerated to minimize morbidity and its associated human and financial costs, as their management mainly by inhaler therapy so adherence to inhaler therapy is an important entity to be researched upon so that our study aimed at determining factors affecting adherence to inhaled therapy in patients with bronchial asthma and COPD.
Our study included 300 patients (164 males and 136 females). the mean age for the studied population was 51.5 years, 164 (54.67%) cases were males and
136 (45.73) cases were females. 153 (51%) cases were rural, 147 (49%) cases were urban. 199 (66.33%) cases were illiterate, 37 (12%) cases were primary, 49 (16.3%) cases were secondary, 6 (2%) cases were graduate, 9 (3%) cases were postgraduate , 37 (12.33%) cases were low socioeconomic status, 254 (84.9%) cases were middle socioeconomic status, 9 (3%) cases were high socioeconomic status and the mean BMI was 25.95.
By comparing patients with bronchial asthma and patients with COPD in the studied population, there were statistically significant differences as regard age, gender, residence, body mass index, educational level and socioeconomic status respectively, where older age, male gender, rural residence, low BMI, low educational level, low socioeconomic status were more frequent in COPD patients.
There were 144 (48%) cases had asthma and 156 (52%) cases had COPD and obstructive pulmonary function was more frequent in COPD patients than in asthmatic patients , it also shows that the mean FEV1/FVC ratio and (FEV1%) were significantly low in patients with COPD than in asthmatic patients
We found in our study that serum albumin level was significantly lower in COPD patients than in asthmatic patients.
We found in our study that there was no statistically significant relationship between patients with asthma and COPD as regard duration of the disease or number of emergency visits in the last year
We found in our study that the most common comorbidities in the studied population, were hypertension ( 22.3% ), ENT diseases ( 22.3% ), then cardiac diseases ( 21.3% ) then D.M ( 13.3% )
We found in our study that the number of the patients who received one inhaler was 249 ( 83% ) which more than the number of the patients who received two inhalers which was 51 ( 17% ) patients. Patients who already on inhaled therapy were 189 patients out of them 51 patients receive 2 inhalers. Among the studied population poor adherence was observed in 124 ( 35.3% ) and both intermediate and good adherence was observed in 227 ( 64.6% ). Also naive patients were 111 and most of them were poor adherent which was statistically significant.
There was no statistically significant relationship between demographic data and adherence in asthmatic patients already on inhaler therapy and naive patients & It was found that there was statistically significant relationship between adherence and socioeconomic status in patients with COPD already on therapy and statistically significant relationship as regard residence in COPD naive patients.
It was found that there was no statistically significant relationship between adherence to inhaler therapy in both COPD and asthma and disease severity or disease characteristics in both asthma and COPD apart from COPD patients on therapy, good adherence was encountered in patients who had 2- 4 emergency visits in the last year, it was statistically significant
We also found in our study that there was statistically significant relation between poor adherence and patients with cardiac diseases also there was significant relation between good adherence and patients who had ENT diseases and no significant relation between adherence and number of comorbidities
It was found that both asthma and COPD patients were frequently using the inhaler twice daily and patients with COPD preferred to use the once daily inhaler more frequently than asthmatic patients, also asthmatic patients used the on need more frequently than COPD patients, the inhaler that of 5 minutes of onset of action was frequently used by both asthma and COPD patients than other types of inhalers, it was found that aerolizer , MDI, turbohaler and handihaler were frequently used by both asthma and COPD, it was found that budesonide, formetrol, salbutamol and budesonide formetrol were frequently used by both asthma and COPD patients in order than other types of drugs
It was found that good adherence frequently encountered among asthmatic patients who used inhaler twice daily ,who used drugs its onset of action 5 - <20 minutes, who used Aerolizer and turbohaler and who used budesonide and budesonide formetrol and it was statistically significant.
It was found that good adherence frequently encountered among patients with COPD who used inhaler twice daily, who used Aerolizer and handihaler and who used formetrol and tiotropium and it was statistically significant.
Conclusion
from this study we can concluded that:
Adherence to inhaled therapy among asthmatic and COPD patients is a complex issue that can be affected by multiple factors, some of these factors are related to the patient, some are related to the disease and some are related to the inhaled therapy itself.
1- Good adherence to inhaled therapy was observed in 124 ( 35.3% ) patients and both intermediate and good adherence was observed in 227 ( 64.6% ) patients.
2- Most of the naive patients were poor adherent to inhaled therapy.
3- There was no relationship between demographic data and adherence in asthmatic patients. However there was significant relation between adherence and socioeconomic status and residence in COPD patients.
4- Patients with bronchial asthma had better adherence to inhaled therapy than patients with COPD.
5- There was no statistically significant relationship between disease severity and adherence to inhaler therapy in both COPD and asthma patients. However good adherence was frequently encountered in patients with COPD who had 2-4 emergency visits in the last year.
6- Good adherence was observed frequently in patients who had ENT diseases as comorbidity while poor adherence was observed frequently in patients who had cardiac disease. However there was no significant relation between number of comorbidities and adherence to inhaled therapy.
7- Good adherence was frequently encountered among asthmatic patients who used inhaler twice daily, who used drugs its onset of action 5- 20 minutes, who used Aerolizer and turbohaler devices and who used budesonide and budesonide/ formetrol.
8- Good adherence was frequently encountered among patients with COPD who used inhaler twice daily, who used Aerolizer and handihaler devices and who used formetrol and tiotropium.
Recommendations
1- Naive patients should be studied in a wide scale studies with good follow up and monitoring after start of therapy.
2- Both objective and subjective methods should be used to measure adherence to inhaled therapy as this is accurate than use of the subjective method only .
3- Other factors that can affect adherence to inhaled therapy such as physician factors , health system factors and drug cost should be included during assessment of adherence.
4- methods for improving adherence as educational programs and behavioral strategies should be included in large studies.