Inhaler Adherence in COPD and Its Clinical and Contextual Associations: A Single-Center Cross-Sectional Study

Effective management of chronic obstructive pulmonary disease (COPD) depends on sustained adherence to inhaled therapies, yet real-world factors associated with inhaler adherence and disease awareness are not fully characterized. This study aimed to evaluate inhaler medication adherence among patients with COPD and to explore its associations with sociodemographic, clinical, and contextual factors, including self-reported disease awareness.

This single-center, cross-sectional descriptive study was conducted between July and October 2025 in the Chest Diseases Outpatient Clinic of a tertiary hospital. Patients aged ≥18 years with a confirmed diagnosis of COPD based on GOLD 2025 criteria were included. Sociodemographic and clinical data were collected using structured, interviewer-administered questionnaires. Inhaler adherence was assessed using a structured questionnaire adapted from the Test of Adherence to Inhalers (TAI). Symptom burden and dyspnea were evaluated using the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnea scale, respectively. Statistical analyses were performed using IBM SPSS Statistics version 23.0, with a two-sided p value < 0.05 considered statistically significant.

A total of 170 patients were included in the analysis (GOLD group A: 31.2%, group B: 44.1%, and group E: 24.7%). Marital status (p = 0.003), family history of COPD (p<0.001), and home use of nebulizers or oxygen concentrators (p<0.001) were significantly associated with higher inhaler adherence, whereas age, educational level, income status, and smoking status were not. TAI adherence scores did not differ significantly across GOLD groups (p>0.05), whereas exacerbation frequency and hospitalization rates increased significantly with disease severity (p<0.001).

In this single-center cross-sectional study, inhaler adherence in patients with COPD was found to be associated with contextual and social factors, such as marital status, family history of COPD, and home use of respiratory support devices, rather than with demographic characteristics or disease severity. These findings highlight the importance of routinely assessing inhaler use and adherence in clinical practice and suggest that contextual factors may play a role in adherence behaviors, in line with current GOLD recommendations.