Evaluation of inhaler satisfaction and medication adherence in patients with chronic obstructive pulmonary disease: A cross-sectional study

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Abstract
A cornerstone of treatment for chronic obstructive pulmonary disease (COPD) is inhalation therapy. However, incorrect use of inhalers can increase the risk of exacerbations. Adherence to inhaled medications and patient satisfaction are interrelated and play critical roles in achieving optimal symptom control. This study aimed to evaluate patient satisfaction with and adherence to inhalers among individuals with COPD. A prospective single-center observational study was conducted in a South Indian hospital, assessing inhaler adherence using the Test of Adherence to Inhalers and patient satisfaction using the Feeling of Satisfaction with Inhaler (FSI-10) questionnaire. A logistic regression model was used to identify factors associated with high inhaler satisfaction. Among 377 COPD patients (mean age = 61.8 ± 10.7 years), 57.3% reported high inhaler satisfaction (FSI-10 ≥ 43), which was associated with older age, male sex, longer disease duration, fewer current smokers, comorbidities, milder disease (global initiative for chronic obstructive lung disease I–II), dry powder inhaler use, single-inhaler therapy, long-acting beta 2 -agonist/long-acting muscarinic antagonist regimens, and fewer exacerbations (all P < .05). Good adherence (Test of Adherence to Inhalers [10-item questionnaire] = 50) was observed in 32.9%, associated with adequate inhaler knowledge, absence of forgetfulness or fear, single-inhaler use, and higher satisfaction (all P < .001). In multivariable analyses, high satisfaction was independently associated with age >60 years (Adjusted Odds Ratio [aOR] = 3.84; confidence interval [CI] = 2.12–6.97), comorbidities (aOR = 1.67; CI = 1.04–2.68), whereas multiple inhaler use (aOR = 0.62; 95% CI = 0.39–0.99) and global initiative for chronic obstructive lung disease III to IV (GOLD III to IV) (aOR = 0.48; 95% CI = 0.29–0.79) were associated with lower satisfaction.. Good adherence was independently associated with higher education (aOR = 3.12; CI = 1.94–5.02), inadequate inhaler knowledge (Adjusted aOR = 0.31; CI = 0.14–0.69), and higher FSI-10 scores (aOR per unit = 1.18; CI = 1.11–1.26). Satisfaction and adherence were moderately correlated (r = 0.46; P < .001). This study found that high inhaler satisfaction was common among patients with COPD, whereas full adherence was less frequent. Satisfaction and adherence were associated with age, disease severity, inhaler regimen complexity, education, and inhaler knowledge. The moderate positive correlation between satisfaction and adherence suggests a potential relationship that warrants further investigation in longitudinal or interventional studies.

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