Adherence to inhaled therapy and its impact on chronic obstructive pulmonary disease (COPD).

BACKGROUND: COPD is a treatable disease with increasing prevalence worldwide. Treatment aims to stop disease progression, to improve quality of life, and to reduce exacerbations. We aimed to evaluate the association of the stage of COPD on adherence to inhaled therapy and the relationship between adherence and COPD exacerbations. METHODS: A retrospective analysis of patients hospitalized for acute exacerbation of COPD in a tertiary care hospital in Upper Austria and discharged with a guideline conform inhaled therapy was performed. Follow-up data on medical utilization was recorded for the subsequent 24 months. Adherence to inhaled therapy was defined according to the percentage of prescribed inhalers dispensed to the patient and classified as complete (> 80%), partial (50-80%) or low (< 50%). RESULTS: Out of 357 patients, 65.8% were male with a mean age of 66.5 years and a mean FEV1 of 55.0%pred. Overall, 35.3% were current smokers, and only 3.9% were never-smokers. In 77.0% inhaled triple therapy (LAMA + LABA + ICS) was prescribed. 33.6% showed complete adherence to their therapy (33.2% in men, 34.4% in women), with a mean age of 67.0 years. Mean medication possession ratio by GOLD spirometry class I - IV were 0.486, 0.534, 0.609 and 0.755, respectively (p = 0.002). Hence, subjects with complete adherence to therapy had a significantly lower FEV1 compared to those with low adherence (49.2%pred. vs 59.2%pred., respectively; p <  0.001). The risk of exacerbations leading to hospitalization was 10-fold higher in GOLD spirometry class IV compared to GOLD spirometry class I, which was even more evident in multivariate analysis (OR 13.62). CONCLUSION: Complete adherence to inhaled therapy was only seen in 33.6% and was higher among those with more severe COPD. TRIAL REGISTRATION: Not applicable.

Medication adherence in patients with dementia: an Austrian cohort study.

Sustained treatment with effective doses of cholinesterase inhibitors or memantine is crucial to transfer treatment effects in dementia. Numerous studies, with often small samples sizes, describe low adherence rates. The purpose of current study was to examine the medical adherence of antidementia therapy in Austria. We analyzed the data of 10 Austrian Health Insurance Funds, including treatment-naive dementia patients. Study outcome measures were discontinuation, switching, number of days on therapy, Medication-Possession-Ratio, and compliance. A total of 15,809 patients (mean age: 79.9 y, female: 67.3%) met the study's inclusion criteria. After stratification by index medication there were 40.3% on donepezil (n=6371); 26.6% on rivastigmine (n=4206); 15.3% on galantamine (n=2424); and 17.8% on memantine (n=2808). After 6 and 12 months on therapy, 5376 (34.0%) and 9243 (58.5%) patients stopped the initially prescribed antidementia therapy; after 12 months the highest discontinuation rate was seen for patients taking rivastigmine (67.3%), whereas patients on memantine (45.0%) had the lowest. After 12 months, a total of 1874 (11.9%) patients switched from their index medication to another cholinesterase inhibitor or memantine. A total of 6163 patients (39.0%) were compliant (Medication-Possession-Ratio >80%) during the first 6 months and 5366 patients (33.9%) during 12 months of the study. Our study shows that memantine-treated patients adhere significantly better to treatment. Specifically, after 12 months, 45.0% discontinued medication, 7.9% switched, and 50.8% of patients on therapy were compliant.

Genome-wide association studies in an isolated founder population from the Pacific Island of Kosrae.

It has been argued that the limited genetic diversity and reduced allelic heterogeneity observed in isolated founder populations facilitates discovery of loci contributing to both Mendelian and complex disease. A strong founder effect, severe isolation, and substantial inbreeding have dramatically reduced genetic diversity in natives from the island of Kosrae, Federated States of Micronesia, who exhibit a high prevalence of obesity and other metabolic disorders. We hypothesized that genetic drift and possibly natural selection on Kosrae might have increased the frequency of previously rare genetic variants with relatively large effects, making these alleles readily detectable in genome-wide association analysis. However, mapping in large, inbred cohorts introduces analytic challenges, as extensive relatedness between subjects violates the assumptions of independence upon which traditional association test statistics are based. We performed genome-wide association analysis for 15 quantitative traits in 2,906 members of the Kosrae population, using novel approaches to manage the extreme relatedness in the sample. As positive controls, we observe association to known loci for plasma cholesterol, triglycerides, and C-reactive protein and to a compelling candidate loci for thyroid stimulating hormone and fasting plasma glucose. We show that our study is well powered to detect common alleles explaining >/=5% phenotypic variance. However, no such large effects were observed with genome-wide significance, arguing that even in such a severely inbred population, common alleles typically have modest effects. Finally, we show that a majority of common variants discovered in Caucasians have indistinguishable effect sizes on Kosrae, despite the major differences in population genetics and environment.