TY - JOUR T1 - Adherence with inhaled respiratory therapeutics is associated with reduced acute exacerbations of chronic obstructive pulmonary disease JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - 4868 AU - Richard Mularski AU - MaryAnn McBurnie AU - Jerena Donovan AU - Kari Walker AU - Suzanne Gillespie AU - Vollmer William Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/4868.abstract N2 - Background: Adherence to inhaled chronic obstructive pulmonary disease (COPD) medications is variable and generally low. We examined the association of medication adherence with subsequent acute exacerbations (AE) among adult members of a large health maintenance organization.Methods: We used data from electronic medical records to identify individuals with COPD defined by ICD-9 coded encounters during the period 2000-2008 and computed modified medication possession ratio (mMPR) to measure adherence to three classes of inhaled COPD medications. Using Cox regression, we evaluated the association between six-month adherence score (calculated forward from index date) and subsequent risk of first AE-COPD within 12 months, adjusting for age, race, sex, baseline smoking status, body habitus, and co-morbidities. AE-COPD was defined by outpatient/emergency encounters with steroid use or hospitalization.Results: We identified 26,516 individuals with COPD (59% female, mean age 61±13 years) of whom 80% contributed adherence data. Adherence rates (mMPR±S.D, number contributing) were 0.62±0.34, n=11317 for anticholinergics (Ach), 0.61±0.32, n=17018 for inhaled corticosteroids (ICS), and 0.66±0.29, n=5336 for long-acting beta-agonists (LABA). The relative risk for subsequent AE based on a 0.20 difference in mMPR at the start of follow-up was 0.86 (95% CI=0.84, 0.93) for ICS, 0.91 (0.84, 1.00) for LABA, and 0.89 (0.84, 0.93) for Ach.Conclusions: Better adherence to any of the major classes of inhaled controller therapeutics reduced the risk of subsequent AE-COPD.Funding: Investigator Initiated Grant, Novartis Pharmaceuticals Corporation. ER -