Impact of Clinical Pharmacological Intervention on Treatment Adherence among Adult Patients with Bronchial Asthma and COPD: A Randomised Clinical Study

Introduction: Adherence to the management of asthma and Chronic Obstructive Pulmonary Disease (COPD) is often suboptimal, which increases morbidity and mortality associated with these chronic respiratory diseases. The effectiveness of asthma and COPD education and self-management programmes on medication adherence and health outcomes is less well evaluated. Aim: To assess the impact of clinical pharmacological interventions, such as counselling and monitoring reinforcement, on treatment adherence in adult patients with asthma and COPD. Materials and Methods: This randomised clinical study was conducted in the Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, Eastern India. Eighty screen-eligible patients were randomly divided into two groups: the Intervention Group (IG) and the Non Intervention Group (Non IG), and were followed-up bimonthly for one year. The intervention consisted of a basic introduction to asthma or COPD, factors causing exacerbations, prevention of attacks, appropriate inhaler use techniques, etc. The appropriateness of inhalation technique was assessed using a structured observation checklist and the Device Appropriateness Index (DAI). An 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess adherence. Additionally, the Adherence Index (AI) of the patients was calculated by multiplying the MMAS-8 score with the DAI score. Results: In the study, there were 29 (52.73%) males and 26 (47.27%) females in the asthma group, while the COPD group comprised 18 (72%) males and 7 (28%) females, with mean ages of 42.86±14.3 years in the asthma group and 51.12±8.6 years in the COPD group. The MMAS-8 score was found to be better in the IG compared to the Non IG, with statistically significant differences observed from the 4th follow-up visit onwards. By the 6th follow-up visit in the IG, 42.5% demonstrated high adherence and 57.5% showed moderate adherence, with no patients falling into the low adherence category. There was significant improvement in the DAI in the IG compared to the Non IG from the first follow-up visit onwards and this improvement persisted across all subsequent visits. Conclusion: The findings of the present study suggest that clinical pharmacological intervention is of great value in optimising treatment adherence among asthma and COPD patients, and it can be routinely incorporated into clinical care.