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      Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study

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          Abstract

          Background

          This study assessed the adherence profiles to inhaled therapies and the agreement between two patient self-report adherence methods in stable COPD lpatients from seven Latin American countries.

          Methods

          This observational, cross-sectional, multinational, multicenter study involved 795 COPD patients (post-bronchodilator forced expiratory volume in 1 second/forced vital capacity [FEV 1/FVC] <0.70). Adherence to inhaled therapy was assessed using the specific Test of Adherence to Inhalers (10-item TAI) and the generic 8-item Morisky Medication Adherence Scale (MMAS-8) questionnaires. The percentage agreement and the kappa index were used to compare findings.

          Results

          59.6% of patients were male (69.5±8.7 years); post-bronchodilator FEV 1 percent predicted was 50.0±18.6%. Mean values for 10-item TAI and MMAS-8 questionnaires were 47.4±4.9 and 6.8±1.6, respectively. Based on the TAI questionnaire, 54.1% of patients had good, 26.5% intermediate, and 19.4% poor adherence. Using the MMAS-8 questionnaire, 51% had high, 29.1% medium, and 19.9% low adherence. According to both questionnaires, patients with poor adherence had lower smoking history, schooling but higher COPD Assessment Test score, exacerbations in the past-year and post-bronchodilator FEV 1. The agreement between 10-item TAI and MMAS-8 questionnaires was moderate (Kappa index: 0.42; agreement: 64.7%).

          Conclusion

          Suboptimal adherence to medication was frequent in COPD patients from Latin America. Low adherence was associated with worse health status impairment and more exacerbations. There was inadequate agreement between the two questionnaires. Greater effort should be made to improve COPD patients’ adherence to treatment, and assessment of adherence with more specific instruments, such as the TAI questionnaire, would be more convenient in these patients.

          Clinical Trial Registration

          NCT02789540

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          Most cited references18

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          Predictive validity of a medication adherence measure in an outpatient setting.

          This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
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            Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.

            This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
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              Objective Assessment of Adherence to Inhalers by Patients with Chronic Obstructive Pulmonary Disease.

              Objective adherence to inhaled therapy by patients with chronic obstructive pulmonary disease (COPD) has not been reported.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 November 2017
                2017
                : 12
                : 11
                : e0186777
                Affiliations
                [1 ] Universidad Central de Venezuela, Caracas, Venezuela
                [2 ] Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
                [3 ] Universidad de la República, Montevideo, Uruguay
                [4 ] Fundación Neumológica Colombiana, Bogotá, Colombia
                [5 ] Clínica Americana, San José, Costa Rica
                [6 ] Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
                [7 ] Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
                [8 ] Hospital Privado Universitario de Córdoba, Córdoba, Argentina
                [9 ] AstraZeneca, Wilmington, Delaware, United States of America
                [10 ] Department of Pneumology, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) Barcelona, Spain
                Lee Kong Chian School of Medicine, SINGAPORE
                Author notes

                Competing Interests: MMO: no real or perceived conflicts of interest. AM: Has been paid for her work as a statistician for the LASSYC study. FCW: no real or perceived conflicts of interest. MVLV: no real or perceived conflicts of interest. AC: no real or perceived conflicts of interest. LU: no real or perceived conflicts of interest. AR-V: no real or perceived conflicts of interest. LM: no real or perceived conflicts of interest. AL: no real or perceived conflicts of interest. FS: Employee of AstraZeneca. MM: no real or perceived conflicts of interest. This observational study was funded by AstraZeneca Latin America. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-5274-7574
                Article
                PONE-D-17-15979
                10.1371/journal.pone.0186777
                5687703
                29140978
                ba8141c2-3f9e-497b-b3b5-ccb33317423b
                © 2017 Montes de Oca et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 June 2017
                : 6 October 2017
                Page count
                Figures: 2, Tables: 6, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100004325, AstraZeneca;
                This observational study was funded by AstraZeneca Latin America. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. There are no other relevant declarations relating to employment, consultancy, patents, products in development or marketed products.
                Categories
                Research Article
                Medicine and Health Sciences
                Pulmonology
                Chronic Obstructive Pulmonary Disease
                Medicine and Health Sciences
                Health Care
                Patients
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                Medicine and Health Sciences
                Public and Occupational Health
                Physical Activity
                People and places
                Population groupings
                Ethnicities
                Latin American people
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Respiration
                Inhalation
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Respiration
                Inhalation
                Medicine and Health Sciences
                Pulmonology
                Asthma
                Medicine and Health Sciences
                Pulmonology
                Dyspnea
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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