Assessment of adherence to inhaled therapy for asthma and COPD in Bulgaria

Non-adherence to therapy in asthma and chronic obstructive pulmonary disease (COPD) compromises treatment, impairs quality of life, and causes significant economic losses. <bold>Aim:</bold> To assess adherence to inhaled therapy in patients with asthma and COPD in Bulgaria. <bold>Materials and methods:</bold> 4020 patients with asthma or COPD and an average age of 59.43±14.66 years were included in this survey. Demographic data and a questionnaire to assess adherence to inhaler therapy (TAI® test; Test of Adherence to Inhalers®) were collected from all participants. <bold>Results:</bold> Non-adherence to the therapy was found in 77.2% of the patients. Factors such as gender, education and smoking did not affect adherence to therapy. Patients showed regional differences in deliberate and unwitting non-adherence. Erratic and deliberate non-adherence become more common with increasing disease duration. Unwitting non-adherence to therapy occurs more frequently with the use of a pMDI compared to a DPI device. In some regions of the country, there is an increased correlation between erratic or deliberate non-adherence and pMDIs compared to DPIs. There was a moderately high correlation between erratic and deliberate non-adherence (r=0.632; p<0.001) and a low positive correlation between erratic and unwitting non-adherence (r=0.181; p<0.001). <bold>Conclusion:</bold> Non-adherence to inhaled therapy for asthma and COPD in Bulgaria is very high and varies in different regions of the country. The TAI questionnaire enables rapid assessment of the main types of non-adherence to therapy. Correcting the causes leading to non-adherence to therapy reduces the frequency of exacerbations and improves the quality of life in patients with asthma and COPD.