The Impact of Depression on COPD Medication Adherence

Depression was found to be a significant risk factor for non-adherence to maintenance mediations in newly diagnosed chronic obstructive pulmonary disease (COPD) patients.

Information from Medicare administrative claims data was collected for a study from the Centers for Medicare and Medicaid Services Chronic Condition Data Warehouse. Researchers assessed a 5% randomized sample of Medicare beneficiaries with an average age of 68-years-old from 2006 to 2012.

It included beneficiaries with 2 years of continuous Medicare parts A, B, and D coverage and at least 2 prescription fills for inhaled corticosteroids, long-acting ß-agonists, and long-acting anticholinergics. For the study, adherence was based on the number of prescriptions filled, and depression was defined as having at least 1 diagnosis code on at least 1 inpatient claim or a minimum of 2 outpatient claims during the study period.

There was a total of 31,033 beneficiaries who met the inclusion criteria.

The results of the study published in Annals of the American Thoracic Society reported that 20% of the total beneficiaries included were diagnosed with depression after having already received a COPD diagnosis. Furthermore, the average monthly adherence to COPD medications were found to be low, peaking at 57% in the month that followed the first prescription fill, and decreasing to 25% within the first 6 months.

“We were able to identify depression as a risk factor for not using COPD medications, finding that older adults with respiratory disease have a tendency to not fully utilize the medications prescribed for their disease,” said researcher Linda Simoni-Wastila, BSPharm, MSPH, PhD.

In COPD patients, depression has a prevalence of 17% to 44%, and remains among the most common, least recognized, and undertreated comorbidities in patients with this disease.

“While depression has been associated with reduced maintenance medication use in other chronic conditions, this is the first study to document the role of causality of concomitant depression on reduced COPD medication adherence in older adults with COPD,” Simoni-Wastila said.

Authors noted that physicians should be aware of the potential development of depression, especially in the first 6 months, in older adults newly diagnosed with COPD.

“It is our long-term hope that this study will help policy makers, practitioners, and patients and their caregivers think of their health more holistically, and to consider how the presence of 1 treated or untreated medical condition may influence the progression and management of other medical conditions,” the authors concluded.