Association between MedicationAdherence and Dyspnea Severity inChronic Obstructive Pulmonary DiseasePatients with Multimorbidity

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition that is progressive
and usually occurs with other health problems, poor adherence to medication, and high symptom burden. Comorbid
conditions and poor adherence to maintenance therapy negatively impact functional outcomes and disease control
in COPD patients. Objective: The objective of the study is to assess the burden of comorbidities and medication
adherence and clinical outcomes related to dyspnea in patients with COPD and to find the association between
medication adherence and severity of dyspnea in a tertiary care setting. Materials and Methods: This was a
prospective observational study conducted over a period of 6 months among 153 physician-diagnosed COPD
patients admitted to the inpatient and outpatient departments of a tertiary care teaching hospital in South India. Data
related to demographic details, smoking history, alcohol use, severity of COPD, comorbidity profile, and treatment
patterns were collected by interviewing the patients and reviewing their case records. Medication adherence was
measured by means of the Morisky Medication Adherence Scale (MMAS-8) which is an 8-item licensed tool. The
severity of dyspnea was graded according to the modified Medical Research Council (mMRC) dyspnea scale.
Results were expressed in terms of descriptive statistics presenting frequencies and percentages. The Chi-square
test was applied to find the association between categorical variables. A P < 0.05 was considered statistically
significant. Results: Most participants were aged 60 years and above (70.6%) and male (97.4%). Current smoking
was noted in 53.6% of patients; moderate-to-severe COPD cases predominating over GOLD stage II and III at
39.2% and 35.9%, respectively. Comorbidity
burden was high, with 58.8% of patients having
two or more comorbid conditions. The most
prevalent comorbidities were hypertension
(49.7%) and diabetes mellitus (37.9%). Longacting muscarinic antagonist/long-acting beta
agonist dual therapy was the main treatment in
30.1% and triple therapy in 28.1%. Only 15.7%
of patients had high medication adherence, with
40.5% having low adherence. Most patients
suffered from clinically significant dyspnea, with 75.8% of the cohort having mMRC grades 2–4. There was a statistically significant association between medication adherence
and mMRC dyspnea severity (P < 0.001) – poorer adherence linked with higher dyspnea grades. Conclusion: Patients with
COPD at this tertiary care institution had a high multimorbidity burden, considerable symptom-related functional limitation, and
mostly suboptimal medication adherence. This last factor was associated with worsening dyspnea severity – shining a spotlight
on the need for adherence-focused interventions, inhaler counseling, and multidisciplinary management care for COPD patients