Estrategias para evaluar la adherencia a la terapia inhalatoria. Estado del arte sobre la utilización de cuidados de salud y costos económicos
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La terapia inhalatoria (TI) ha tenido un gran avance en las últimas décadas gracias a la evolución tecnológica y la investigación realizada en este campo. Esta intervención es un pilar clave en el manejo integral para el control de los síntomas de enfermedades obstructivas como la enfermedad pulmonar obstructiva crónica y el asma. La TI, como todo tratamiento, se enfrenta a diferentes amenazas que pueden atentar contra sus beneficios. Una baja adherencia, así como una técnica inadecuada en la administración del fármaco, son aspectos que deben ser controlados y corregidos para favorecer los efectos positivos de la TI. En esta revisión, abordamos el potencial impacto que tiene una baja adherencia a la TI en los gastos en salud, mencionando las diferentes metodologías utilizadas para medir la adherencia.
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Hickey AJ. Emerging trends in inhaled drug delivery. Adv Drug Deliv Rev 2020;157:63–70. Doi: 10.1016/j.addr.2020.07.006.
Clark AR. Half a Century of Technological Advances in Pulmonary Drug Delivery: A Personal Perspective. Frontiers in Drug Delivery 2022;2. Doi: 10.3389/fddev.2022.871147.
Liang Y, Mak JCW. Inhaled Therapies for Asthma and Chronic Obstructive Pulmonary Disease. Curr Pharm Des 2021;27(12):1469–1481. Doi: 10.2174/1389201021666201126144057.
Heaney LG, McGarvey LPA. Personalised Medicine for Asthma and Chronic Obstructive Pulmonary Disease. Respiration 2017;93(3):153–161. Doi: 10.1159/000455395.
Usmani OS, Hickey AJ, Guranlioglu D et al. The Impact of Inhaler Device Regimen in Patients with Asthma or COPD. J Allergy Clin Immunol Pract 2021;9(8):3033-3040.e1. Doi: 10.1016/j.jaip.2021.04.024.
Lemmens KMM, Nieboer AP, Huijsman R. A systematic review of integrated use of disease-management interventions in asthma and COPD. Respir Med 2009;103(5):670–691. Doi: 10.1016/j.rmed.2008.11.017.
Zhang S, Wang J, Li X et al. Comparative effectiveness and safety of triple therapy and non-triple therapy interventions for COPD: an overview of systematic reviews. Ther Adv Respir Dis 2024;18. Doi: 10.1177/17534666241259634.
Vauterin D, Van Vaerenbergh F, Grymonprez M et al. Medication adherence to inhalation therapy and the risk of COPD exacerbations: a systematic review with meta-analysis. BMJ Open Respir Res 2024;11(1):e001964. Doi: 10.1136/bmjresp-2023-001964.
Sánchez-Nieto JM, Bernabeu-Mora R, Fernández-Muñoz I et al. Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma. NPJ Prim Care Respir Med 2022;32(1):1. Doi: 10.1038/s41533-021-00262-8.
Nelson HS. Inhalation devices, delivery systems, and patient technique. Ann Allergy Asthma Immunol 2016;117(6):606–612. Doi: 10.1016/j.anai.2016.05.006.
Braido F, Chrystyn H, Baiardini I et al. “Trying, But Failing” — The Role of Inhaler Technique and Mode of Delivery in Respiratory Medication Adherence. J Allergy Clin Immunol Pract 2016;4(5):823–832. Doi: 10.1016/j.jaip.2016.03.002.
Chakrabarti S. What’s in a name? Compliance, adherence and concordance in chronic psychiatric disorders. World J Psychiatry 2014;4(2):30. Doi: 10.5498/wjp.v4.i2.30.
Vrijens B, Dima AL, Van Ganse E et al. What We Mean When We Talk About Adherence in Respiratory Medicine. J Allergy Clin Immunol Pract 2016;4(5):802–812. Doi: 10.1016/j.jaip.2016.05.019.
Holmes J, Heaney LG. Measuring adherence to therapy in airways disease. Breathe 2021;17(2):210037. Doi: 10.1183/20734735.0037-2021.
Jensen FF, Håkansson KEJ, Overgaard Nielsen B et al. Self-reported vs. objectively assessed adherence to inhaled corticosteroids in asthma. Asthma Res Pract 2021;7(1):7. Doi: 10.1186/s40733-021-00072-2.
Sun Y, Jariwala S, Reznik M. Measurement of adherence to inhaled corticosteroids by self-report and electronic medication monitoring. J Asthma 2023;60(7):1299–1305. Doi: 10.1080/02770903.2022.2144352.
Daniels T, Goodacre L, Sutton C et al. Accurate Assessment of Adherence: self-report and clinician report vs electronic monitoring of nebulizers. Chest 2011;140(2):425–432. Doi: 10.1378/chest.09-3074.
Stirratt MJ, Dunbar-Jacob J, Crane HM et al. Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med 2015;5(4):470–482. Doi: 10.1007/s13142-015-0315-2.
Plaza V, Fernández-Rodríguez C, Melero C et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for Asthma and COPD Patients. J Aerosol Med Pulm Drug Deliv 2016;29(2):142–152. Doi: 10.1089/jamp.2015.1212.
Muneswarao J, Hassali MA, Ibrahim B et al. Translation and validation of the Test of Adherence to Inhalers (TAI) questionnaire among adult patients with asthma in Malaysia. J Asthma 2021;58(9):1229–1236. Doi: 10.1080/02770903.2020.1776728.
Ramadan WH, Sarkis AT. Patterns of use of dry powder inhalers versus pressurized metered-dose inhalers devices in adult patients with chronic obstructive pulmonary disease or asthma: An observational comparative study. Chron Respir Dis 2017;14(3):309–320. Doi: 10.1177/1479972316687209.
Jansen EM, van de Hei SJ, Dierick BJH et al. Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis 2021;13(6):3846–3864. Doi: 10.21037/jtd-20-2360.
Brandstetter S, Finger T, Fischer W et al. Differences in medication adherence are associated with beliefs about medicines in asthma and COPD. Clin Transl Allergy 2017;7(1):39. Doi: 10.1186/s13601-017-0175-6.
George J, Kong DCM, Stewart K. Adherence to disease management programs in patients with COPD. Int J Chron Obstruct Pulmon Dis 2007;2(3):253–62.
van Boven JFM, Lavorini F, Agh T et al. Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. J Allergy Clin Immunol Pract 2024;12(5):1228–1243. Doi: 10.1016/j.jaip.2023.12.049.
Pattock AM, Locke ER, Hebert PL et al. Predictors of Patient-reported and Pharmacy Refill Measures of Maintenance Inhaler Adherence in Veterans with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2024;21(3):384–392. Doi: 10.1513/AnnalsATS.202211-975OC.
Rasu RS, Hunt SL, Dai J et al. Accurate Medication Adherence Measurement Using Administrative Data for Frequently Hospitalized Patients. Hosp Pharm 2021;56(5):451–461. Doi: 10.1177/0018578720918550.
Asamoah-Boaheng M, Osei Bonsu K, Farrell J et al. Measuring Medication Adherence in a Population-Based Asthma Administrative Pharmacy Database: A Systematic Review and Meta-Analysis. Clin Epidemiol 2021;13:981–1010. Doi: 10.2147/CLEP.S333534.
Bischof AY, Cordier J, Vogel J et al. Medication adherence halves COPD patients’ hospitalization risk – evidence from Swiss health insurance data. NPJ Prim Care Respir Med 2024;34(1):1. Doi: 10.1038/s41533-024-00361-2.
Yu AP, Guérin A, Ponce de Leon D et al. Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers. J Med Econ 2011;14(4):486–496. Doi: 10.3111/13696998.2011.594123.
Rasu RS, Hunt SL, Dai J et al. Accurate Medication Adherence Measurement Using Administrative Data for Frequently Hospitalized Patients. Hosp Pharm 2021;56(5):451–461. Doi: 10.1177/0018578720918550.
Rand CS, Wise RA, Nides M et al. Metered-Dose Inhaler Adherence in a Clinical Trial. Am Rev Resp Dis 1992;146(6):1559–1564. Doi: 10.1164/ajrccm/146.6.1559.
Bender B, Wamboldt F, O’Connor SL et al. Measurement of children’s asthma medication adherence by self report, mother report, canister weight, and Doser CT. Ann Allergy Asthma Immunol 2000;85(5):416–421. Doi: 10.1016/S1081-1206(10)62557-4.
Brock TP, Wessell AM, Williams DM et al. Accuracy of Float Testing for Metered-Dose Inhaler Canisters. J Am Pharm Assoc 2002;42(4):582–586. Doi: 10.1331/108658002763029553.
Chan AHY, Harrison J, Black PN et al. Using Electronic Monitoring Devices to Measure Inhaler Adherence: A Practical Guide for Clinicians. J Allergy Clin Immunol Pract 2015;3(3):335-349.e5. Doi: 10.1016/j.jaip.2015.01.024.
Taylor TE, Zigel Y, De Looze C et al. Advances in Audio-Based Systems to Monitor Patient Adherence and Inhaler Drug Delivery. Chest 2018;153(3):710–722. Doi: 10.1016/j.chest.2017.08.1162.
Zabczyk C, Blakey JD. The Effect of Connected “Smart” Inhalers on Medication Adherence. Front Med Technol 2021;3. Doi: 10.3389/fmedt.2021.657321.
Julius SM, Sherman JM, Hendeles L. Accuracy of Three Electronic Monitors for Metered-Dose Inhalers. Chest 2002;121(3):871–876. Doi: 10.1378/chest.121.3.871.
Chan AHY, Pleasants RA, Dhand R et al. Digital Inhalers for Asthma or Chronic Obstructive Pulmonary Disease: A Scientific Perspective. Pulm Ther 2021;7(2):345–376. Doi: 10.1007/s41030-021-00167-4.
Hassall D, Brealey N, Wright W et al. Hair analysis to monitor adherence to prescribed chronic inhaler drug therapy in patients with asthma or COPD. Pulm Pharmacol Ther 2018;51:59–64. Doi: 10.1016/j.pupt.2018.07.001.
Hassall D, Brealey N, Wright W et al. Hair analysis to monitor adherence to prescribed chronic inhaler drug therapy in patients with asthma or COPD. Pulm Pharmacol Ther 2018;51:59–64. Doi: 10.1016/j.pupt.2018.07.001.
McNicholl DM, Stevenson M, McGarvey LP et al. The Utility of Fractional Exhaled Nitric Oxide Suppression in the Identification of Nonadherence in Difficult Asthma. Am J Respir Crit Care Med 2012;186(11):1102–1108. Doi: 10.1164/rccm.201204-0587OC.
Loewenthal L, Menzies-Gow A. FeNO in Asthma. Semin Respir Crit Care Med 2022;43(05):635–645. Doi: 10.1055/s-0042-1743290.
Dweik RA, Boggs PB, Erzurum SC et al. An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications. Am J Respir Crit Care Med 2011;184(5):602–615. Doi: 10.1164/rccm.9120-11ST.
Klijn SL, Hiligsmann M, Evers SMAA et al. Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review. NPJ Prim Care Respir Med 2017;27(1):24. Doi: 10.1038/s41533-017-0022-1.
Flom JD, Sicherer SH. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. Pediatrics 2019;144(S1):S55–S56. Doi: 10.1542/peds.2019-2461FFFF.
Plaza V, Giner J, Rodrigo GJ et al. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. J Allergy Clin Immunol Pract 2018;6(3):987–995. Doi: 10.1016/j.jaip.2017.12.032.
Barbara S, Kritikos V, Bosnic-Anticevich S. Inhaler technique: does age matter? A systematic review. Eur Resp Rev 2017;26(146):170055. Doi: 10.1183/16000617.0055-2017.
Cho-Reyes S, Celli BR, Dembek C et al. Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies. Chronic Obstr Pulm Dis 2019;6(3):267–280. Doi: 10.15326/jcopdf.6.3.2018.0168.
Sanchis J, Gich I, Pedersen S et al. Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? Chest 2016;150(2):394–406. Doi: 10.1016/j.chest.2016.03.041.
Bosnic-Anticevich SZ, Cvetkovski B, Azzi EA et al. Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management. Pulm Ther 2018;4(1):1–12. Doi: 10.1007/s41030-018-0051-0.
Sanchis J, Gich I, Pedersen S. Systematic Review of Errors in Inhaler Use. Chest 2016;150(2):394–406. Doi: 10.1016/j.chest.2016.03.041.
Sulku J, Bröms K, Högman M et al. Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations. NPJ Prim Care Respir Med 2021;31(1):5. Doi: 10.1038/s41533-021-00218-y.
Kim J-A, Lim MK, Kim K et al. Adherence to Inhaled Medications and its Effect on Healthcare Utilization and Costs Among High-Grade Chronic Obstructive Pulmonary Disease Patients. Clin Drug Investig 2018;38(4):333–340. Doi: 10.1007/s40261-017-0612-2.
Bischof AY, Cordier J, Vogel J et al. Medication adherence halves COPD patients’ hospitalization risk – evidence from Swiss health insurance data. NPJ Prim Care Respir Med 2024;34(1):1. Doi: 10.1038/s41533-024-00361-2.
Alshehri S, Alshibani M. Impact of Medication Adherence on Emergency Department Visits in Patients with COPD in a Single Tertiary Hospital in Saudi Arabia. Int J Chron Obstruct Pulmon Dis 2023;18:593–598. Doi: 10.2147/COPD.S392946.
Mannino DM, Roberts MH, Mapel DW et al. National and Local Direct Medical Cost Burden of COPD in the United States From 2016 to 2019 and Projections Through 2029. Chest 2024;165(5):1093–1106. Doi: 10.1016/j.chest.2023.11.040.
Averell CM, Laliberté F, Germain G et al. Impact of adherence to treatment with inhaled corticosteroids/long-acting β-agonists on asthma outcomes in the United States. Ther Adv Respir Dis 2022;16. Doi: 10.1177/17534666221116997.
Nurmagambetov T, Kuwahara R, Garbe P. The Economic Burden of Asthma in the United States, 2008–2013. Ann Am Thorac Soc 2018;15(3):348–356. Doi: 10.1513/AnnalsATS.201703-259OC.
Toh MR, Ng GXZ, Goel I et al. Asthma prescribing trends, inhaler adherence and outcomes: a Real-World Data analysis of a multi-ethnic Asian Asthma population. NPJ Prim Care Respir Med 2024;34(1):35. Doi: 10.1038/s41533-024-00391-w.
Dal Negro RW, Turco P. The Extra Cost Due to Non-Adherence to Inhaled Treatments in Adolescents with Mild-to-Moderate Persistent Asthma. Children 2023;10(4):615. Doi: 10.3390/children10040615.
Montes de Oca M, Menezes A, Wehrmeister FC et al. Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study. PLoS One 2017;12(11):e0186777. Doi: 10.1371/journal.pone.0186777.
Sokol MC, McGuigan KA, Verbrugge RR et al. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Med Care 2005;43(6):521–530. Doi: 10.1097/01.mlr.0000163641.86870.af.
Yaghoubi M, Adibi A, Safari A et al. The Projected Economic and Health Burden of Uncontrolled Asthma in the United States. Am J Respir Crit Care Med 2019;200(9):1102–1112. Doi: 10.1164/rccm.201901-0016OC.
van Boven JFM, Lavorini F, Agh T et al. Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. J Allergy Clin Immunol Pract 2024;12(5):1228–1243. Doi: 10.1016/j.jaip.2023.12.049.