Disclosures: Anderson reports he served as a consultant for GlaxoSmithKline; received grants from HRSA; and received funding from the Colorado Medicaid Upper Payment Limit Program. Stempel is a clinical consultant to Propeller Health. Please see the study for all other authors’ relevant financial disclosures.
February 22, 2021
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Adherence to asthma, COPD medications varies by age

Disclosures: Anderson reports he served as a consultant for GlaxoSmithKline; received grants from HRSA; and received funding from the Colorado Medicaid Upper Payment Limit Program. Stempel is a clinical consultant to Propeller Health. Please see the study for all other authors’ relevant financial disclosures.
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A new study highlights age-specific differences in adherence to asthma and COPD medications, with the lowest adherence in young adults and the highest adherence in children and older adults.

Researchers used the Propeller Health digital health platform to track medication use. The platform works by attaching a small sensor to a patient’s existing inhaler, which tracks medication use and can provide insights on adherence, symptoms and triggers to the Propeller Health app.

“This study highlights that a ’one-size-fits-all’ approach would not work for improving medication adherence,” William C. Anderson, MD, Director of Multidisciplinary Asthma Clinic at Children’s Hospital Colorado, Aurora, told Healio. “We need to explore first the underlying reasons for the adherence patterns and barriers to care in each age group and then develop tailored strategies to improve adherence by age.”

Medication utilization by age

Researchers analyzed data collected from 6,474 patients aged 4 years and older with self-reported asthma (mean age, 34.4 years) and 1,911 with self-reported COPD (mean age, 62.2 years) using the Propeller Health platform from January 2017 to September 2019. The mean age in the asthma group was 34.4 years and the mean age in the COPD group was 62.2 years.

William C. Anderson, MD
William C. Anderson, MD

Patient attached the electronic medication monitor to their controller and rescue inhalers. The electronic medication monitors recorded the date and time of each actuation of controllers. Patients completed an Asthma Control Test (ACT), childhood ACT or COPD assessment test using the Propeller Health app at baseline and monthly during the study. Daily controller adherence was assessed as the total number of controller actuations recorded by the electronic monitors divided by the number of prescribed actuations.

Eighty percent of patients with asthma completed the ACT or childhood ACT, and 20.4% had well-controlled asthma. Eighty percent of patients with COPD completed the COPD assessment test, and 60.7% had higher-burden COPD.

David A. Stempel, MD
David A. Stempel, MD

According to the results, mean daily controller adherence was 51.3% among patients with asthma and 66.6% among patients with COPD.

Controller adherence in patients with asthma was lowest among adolescents and young adults. Mean daily adherence was:

  • 54.32% in patients aged 4 to 11 years;
  • 43.37% in patients aged 12 to 17 years;
  • 39.74% in patients aged 18 to 29 years;
  • 47.72% in patients aged 30 to 39 years;
  • 54.87% in patients aged 40 to 49 years;
  • 61.54% in patients aged 50 to 59 years; and
  • 67.96% in patients aged 60 years and older.

Mean daily controller adherence in patients with COPD was:

  • 54.91% in patients aged 40 to 49 years;
  • 64.39% in patients aged 50 to 59 years; and
  • 69.65% in patients aged 60 to 69 years.

Only 13% of patients aged 18 to 29 years had well-controlled asthma. Higher levels of well-controlled asthma were recorded in patients aged 4 to 11 years (29.9%) and those aged 60 years and older (31.2%). For patients aged at least 40 years, controller adherence was higher in older patient age groups, but consistent in both asthma and COPD, according to the researchers.

For patients with asthma at baseline, mean daily short-acting beta agonist use was 0.81 puffs per day. As age increased, so did SABA use, with 1.06 puffs per day recorded among patients aged 30 to 39 years, before demonstrating a progressive decline to 0.8 puffs per day among those aged at least 40 years. For patients with COPD at baseline, mean daily SABA use was consistent across all age groups and nearly double of what was observed among those with asthma in the same age groups, according to the researchers.

The data were published in The Journal of Allergy and Clinical Immunology: In Practice.

‘Pinpoint challenges in patient care’

The digital data compiled in this study can help health care providers tailor care based on patient age, according to the researchers.

“Many patients struggle to take their controller medication on time or as prescribed. By being able to identify patterns of inhaler use, we can pinpoint challenges in patient care and where interventions should be designed and tested,” David A. Stempel, MD, clinical consultant to Propeller Health and co-researcher on the study, told Healio. “Using Propeller’s digital inhaler sensor to monitor patients’ medication use in a real-life setting gives us insight into their behavior that we wouldn’t be able to get in a traditional research setting.”

The low adherence and asthma control scores, and also data that show increased rescue medication use, in adolescents and young adults “shows the need to improve our care for patients as they transition from pediatric to adult care,” Anderson said.

Stempel said this is “likely due to the loss of parental oversight and lower severity of their disease.” Moreover, he said, “children, who are often monitored closely by their parents, are most likely to take their medication as prescribed, along with older adults who have a greater level of maturity and perhaps disease severity as well. Though we suspected this would be the case, it’s incredibly important to confirm these suspicions with hard data from a digital health tool.”

A surprising finding, they said, was similar levels of adherence in patients with COPD and asthma after correcting for age. According to Stempel, “disease state is less of an issue than addressing adherence issues with younger patients.”

Further, “in our research, we continue to see that older adults use digital health and engage with it, despite common misconceptions that older adults will not adopt digital tools,” he said.

Areas for further research include strategies to target digital heath interventions based on age and a deeper understanding of underlying behavioral factors that affect adherence, according to the researchers.

For more information:

William C. Anderson, MD, can be reached at william.anderson@childrenscolorado.org.

David A. Stempel, MD, can be reached at dstempel@propellerhealth.com