Association Between Medication Adherence and Risk of COPD in Adult Asthma Patients: A Retrospective Cohort Study in Canada

Michael Asamoah-Boaheng; Jamie Farrell; Kwadwo Osei Bonsu; Alwell Oyet; William K Midodzi

doi:10.2147/CLEP.S370623

Association Between Medication Adherence and Risk of COPD in Adult Asthma Patients: A Retrospective Cohort Study in Canada

Clin Epidemiol. 2022 Oct 27:14:1241-1254. doi: 10.2147/CLEP.S370623. eCollection 2022.

Authors

Michael Asamoah-Boaheng¹, Jamie Farrell¹, Kwadwo Osei Bonsu², Alwell Oyet³, William K Midodzi¹

Affiliations

¹ Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada.
² School of Pharmacy, Memorial University of Newfoundland, St John's, NL, Canada.
³ Department of Mathematics and Statistics, Memorial University of Newfoundland, St John's, NL, Canada.

Abstract

Background: Poor adherence to prescribed asthma medications and risk of severe asthma exacerbations have been well established. However, the effects of changes in asthma medication compliance levels and subsequent risk of COPD is unknown and yet to be investigated. This study investigated the independent effect of medication adherence (MA) and asthma severity levels on the risk of COPD.

Methods: We used four linked administrative health databases from the Population data BC to identify asthma patients aged 18 years and older between January 1, 1998 and December 31, 1999 without diagnosis of COPD. The primary event was time-to-COPD diagnosis during the follow-up period (January 1, 2000 to December 31, 2018). The proportion of days covered (PDC) - was used as a surrogate measure for medication adherence (MA) assessed at optimal-level (≥ 0.80), Intermediate-level (0.50-0.79), and low-level (< 0.5) of adherence. A propensity adjusted analysis with Marginal Structural Cox (MSC) model was employed to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) for the effect of medication adherence and asthma severity over time.

Results: At cohort entry, the sample included 68,211 asthma patients with an overall mean age of 48.2 years. The 18-year incidence of COPD in asthma patients was 9.8 per 1000-persons year. In an inverse weighted propensity adjusted analysis of the MSC model, higher MA levels were significantly associated with decreased risk of COPD as follows: optimal-level (aHR: 0.19, 95% CI: 0.17-0.24); Intermediate-level (aHR: 0.20, 95% CI: 0.18, 0.23) compared to the low-level adherence group. A significant increase in COPD risk was observed in severe asthma patients with low medication adherence (aHR: 1.72, 95% CI: 1.52-1.93), independent of other patient factors.

Conclusion: Optimal (≥ 0.80) and intermediate adherence (0.5 to 0.79) levels were associated with reduced risk of COPD incidence over time. Interventions aimed at improving adherence to prescribed medications in adult asthma patients should be intensified to reduce their risk of COPD.

Keywords: COPD; asthma; medication adherence; propensity analysis; severe asthma.