Impact-Driven Strategies for Optimizing Inhaled Therapy Adherence in COPD: The OPTIMO Delphi Consensus

Area of Science:

• Pulmonary Medicine
• Clinical Pharmacy
• Health Services Research

Background:

• Medication adherence is a significant challenge in managing chronic obstructive pulmonary disease (COPD).
• Poor adherence negatively impacts symptom control, disease progression, and healthcare utilization in COPD patients.

Purpose of the Study:

• To establish multidisciplinary expert consensus on practical, prioritized interventions for enhancing medication adherence in stable COPD.
• To identify strategies that improve both adherence and clinical outcomes in COPD management.

Main Methods:

• A modified Delphi study involving 73 multidisciplinary COPD management experts.
• Two rounds of a questionnaire assessing 84 statements on non-adherence, impact, contributing factors, assessment, improvement strategies, and prioritization.
• Consensus defined as ≥70% agreement on a 9-point Likert scale.

Main Results:

• Consensus was reached on 74 out of 84 statements.
• Key interventions identified include simplifying and unifying inhalation regimens, and empowering patients.
• Digital and automated adherence assessment tools were deemed feasible for routine practice; reducing inhalation frequency with long-acting medications and tailoring device selection were also highlighted.

Conclusions:

• A practical decalogue for optimizing inhalation therapy in COPD was developed.
• Expert guidance emphasizes once-daily dosing, simplified devices, and patient engagement as the most effective strategies for improving COPD medication adherence.