Adherence to COPD maintenance meds may drop in older, newly diagnosed patients who are depressed

In older adults with newly diagnosed chronic obstructive pulmonary disease (COPD), new episodes of depression may decrease adherence to COPD maintenance medications. Clinicians, therefore, must remain watchful for signs of depression in these patients, especially in the first 6 months after receiving a diagnosis of COPD.

“Prevalence of depression in older adults with COPD ranges from approximately 15%-70%, depending upon COPD severity and whether someone is in the throes of an exacerbation,” said senior author Linda Simoni-Wastila, BSPharm, MSPH, PhD, professor, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy in Baltimore.

“My colleagues and I conducted this study when, in earlier work, we began to see evidence that older adults with COPD had different medication use patterns when we stratified by the presence of certain other conditions. Depression was one of those which caused significant differences in COPD maintenance medication use. We knew when adequately treated, depression can be reduced. This got us to wondering: does depression—treated or untreated—influence use of and adherence to necessary medications used to treat COPD,” she added.

Dr. Simoni-Wastila and colleagues undertook this study using a 5% random sample of Medicare beneficiaries (average age: 68 years; 2006-2012) who had been newly diagnosed with COPD; had at least 2 years of continuous Medicare Parts A, B, and D coverage; and had filled at least two prescriptions for these medications.

They searched claims data from the Centers for Medicare & Medicaid Services Chronic Condition Data Warehouse for prescription fills of the following agents: inhaled corticosteroids, long-acting ß-agonists, and long-acting anticholinergics. Adherence was then assessed using generalized estimated equations as a function of new episodes of depression. Adherence was the primary outcome of the study, and depression was the exposure measure.

Dr. Simoni-Wastila and fellow researchers identified 31,033 Medicare beneficiaries who met the inclusion criteria, of whom 6,227 (20%) were diagnosed with depression after their diagnosis of COPD. They found a low average monthly adherence to COPD maintenance medications, which peaked at 1 month after first fill (57%), and decreased within 6 months, to 35%. Depression, they found, was associated with decreased adherence to COPD maintenance medications (OR: 0.93; 95% CI: 0.89, 0.98).

“COPD is a chronic, progressive, non-curable disease. The first 6 months after COPD diagnosis, many patients feel both the psychological impact of their condition—they will never ‘get better’—as well as the physical impacts of COPD—their difficulty breathing, in physical and functional activities, in quality of life. Once identified, depression takes some time to treat, it takes a while for antidepressants and psychotherapy to kick in,” said Dr. Simoni-Wastila.

“Don’t think of your patients as having only one medical condition or problem. Understand the comorbidities that often occur with the primary problem you are treating, in this case, COPD. There are conditions that often accompany COPD or develop from COPD, including depression, but also anxiety, congestive heart failure, and other conditions. And treating one condition well can influence how well patients respond to treatment for their other conditions,” she concluded.

These findings were published online, June 22, 2015, in the Annals of the American Thoracic Society (AnnalsATS)

This study was funded by the National Institutes of Health.