Inhaler Adherence and Treatment Behaviors in COPD: A Study from Both Sides of the Aegean Sea

Patient adherence is a key factor in the effectiveness of chronic obstructive pulmonary disease (COPD) treatment. The Test of Adherence to Inhalers (TAI-12) scoring system, which evaluates adherence in patients with obstructive lung diseases, consists of 10 patient-rated items. This study aims to assess inhaler adherence levels and their association with COPD outcomes among patients living on both sides of the Aegean Sea-Turkey and Greece-and to identify the main differences among COPD patients in each country.

The cross-sectional study included 300 COPD patients who completed the TAI-12 questionnaire between June and December 2024 from 6 centers in Turkey and Greece (152 Turkish 148 Greek patients). Demographic data, COPD characteristics, and quality of life assessed with the St. George Respiratory Questionnaire (SGRQ) were also evaluated.

There was a significant difference between Turkish and Greek COPD patients regarding age (p = 0.001), presence of comorbidity (p < 0.001), exacerbation history (p < 0.001), and adherence according to the TAI-12 score (p = 0.014). Frequent exacerbation rate and usage of triple therapy were found statistically higher in the Greek COPD group (p < 0.001 and p = 0.021, respectively). There was a positive correlation between TAI-12 score and COPD duration (r = 0.165, p = 0.004) and negative correlations with the number of medications (r = -0.147, p = 0.011), COPD Assessment Test (CAT) score (r = -0.166, p = 0.004), and SGRQ score (r = -0.121, p = 0.036). Good inhaler adherence was observed in COPD patients with lower cumulative tobacco exposure (p = 0.028), longer illness duration (p = 0.009), and lower MRC and CAT scores (p = 0.006 and 0.034, respectively). Inhaler treatment compliance was lower in patients with cough symptoms (p = 0.046). According to binary logistic regression, only disease duration was a significant independent predictor of inhaler adherence (Odds Ratio (OR) = 1.953, 95% Confidence Interval (CI) 1.01-3.39; p = 0.023).

Sociocultural differences and demographic features have been recognized as factors that influence inhaler compliance in COPD, even across two opposite sides of the Aegean. Our study highlights the need for targeted, culturally sensitive strategies to improve inhaler adherence in COPD populations.