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Emergency Medicine Article and Summary

This article studies the efficacy and safety of interventions to improve adherence to treatment in people with COPD

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The focus of the article is to evaluate which approaches help people with COPD maintain their prescription regimen, improve quality of life, and reduce hospital admissions. Secondary outcomes included COPD exacerbations, self-efficacy, adverse events, patient acceptability of intervention, and inhaler technique. 14 studies were included in this intervention review. Patient’s ages ranged from 54-75 years, and COPD severity ranged from mild to very severe. Six studies used simple approaches, which include changing medication dosage, changing the type of inhaler, and starting  Bluetooth inhaler reminder devices. Eight studies used combined approaches, which include nurses or pharmacists giving advice or information about how to improve medication use. 

Single component intervention results varied. A Bluetooth inhaler monitoring device linked to a mobile application providing reminders (beeps and flashes) was no better than a monitoring device without these reminders in promoting compliance. There was little to no benefit of a single Diskus inhaler compared to two separate inhalers (standard therapy). In contrast, a counselling session provided by a pharmacist did improve compliance to medication as measured by prescription refills, as did a transdermal tulobuterol patch compared to the inhaled salmeterol. 

Multi-component interventions included pharmacist-led interventions, face-to-face education on COPD, medication management, management of symptoms, written information, motivational interview technique to increase self-efficacy, development of an individualised action plan and demonstration of the pursed-lip technique as part of the intervention. These interventions, specifically pharmacist-led multi-component interventions, were found to be effective in helping people with COPD adherence. There were also decreased all-cause and COPD-related hospital admissions. However, no differences were found in improving quality of life. 

These results should be interpreted with caution because larger studies are needed to demonstrate effects of these interventions. In addition, specific COPD populations should be studied separately and optimal intervention durations should be determined. Discussions between health professionals and patients are needed in order to determine which intervention would fit best for the patient. 

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