Poor adherence in exacerbating COPD patients: magnitude and related factors at baseline in the MAGNIFY pragmatic trial

David Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to conferenceAbstractpeer-review


Introduction and Objectives
Maintenance inhaled therapies can stabilise COPD symptoms and reduce the risk of exacerbations,
but inhaler adherence is often poor. Patients experiencing frequent exacerbations represent a specific
high-risk population in need of further intervention. Little data exist regarding inhaled medication
adherence amongst exacerbating COPD patients. The MAGNIFY cluster randomised trial is
investigating the effect of a technologically-supported adherence package for exacerbating COPD
patients in primary care. Using baseline data from this trial, we explore inhaler adherence and
compare characteristics of exacerbating COPD patients, stratified by adherence to inhaled
maintenance therapy.
Algorithms run on electronic medical records (EMR) of 137 GP practices identified COPD patients aged
≥40 years, with ≥2 moderate/severe exacerbations in the last two years. EMR-based patient
adherence was based on the 12 months prior to 1st March 2020, if ever prescribed inhaled
maintenance therapy.
Of those with available data, 41.2% of COPD patients (10882/26411) had ≥2 moderate/severe
exacerbations in the last two years. Almost two thirds (6929/10882, 63.7%) of the patient sample were
prescribed triple therapy, with LABA/ICS being the second most common therapy (1699/10882,
15.6%) (Table 1). Over a third of patients (4168/10882, 38.3%) were ≤50% adherent on at least one
therapy. Patients with ≤50% adherence had more health care contacts in the 12 months prior to 1st
March 2022, worse dyspnoea and inhaler technique, and proportionally higher prescriptions for triple
therapy. Furthermore, patients on triple therapy were more likely to have ≤50% adherence compared
to any other therapy type (43.5% vs 31.4% or lower).
Poor adherence was common amongst exacerbating COPD patients, and was associated with more
health care contacts, and worse respiratory symptoms and inhaler technique. Triple therapy was the
most common inhaled maintenance therapy in this patient population, but it also had substantially
lower adherence compared to other therapies. Adherence was worse amongst patients on dual and
triple therapies, indicating that future adherence support interventions should be targeted at these
subgroups. Analyses comparing adherence to open/closed inhaled therapies will be presented at the
Original languageEnglish
Publication statusAccepted/In press - 2022
EventBritish Thoracic Society Winter Meeting 2022 - QEII Centre, London, United Kingdom
Duration: 23 Nov 202225 Nov 2022


ConferenceBritish Thoracic Society Winter Meeting 2022
Country/TerritoryUnited Kingdom
Internet address


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