Relevance of dosage in adherence to treatment with long-acting anticholinergics in patients with COPD

Anticholinergics are administered in two different dosing: one is used for 12 hours and second is used for 24 hours. These dosing where studied by Izquierdo and colleagues to find adherence in a large population of over sixteen thousand people. These people were not given anything different than their regular inhalers and were asked to keep their regimens similar to what they were on previously. This study monitored these people for a year and watched for adherence between people using 12 hours vs. 24 hours. Long-acting cholinergics (LAMA) were the main focus of the study, as the researchers believed that 24 hour dosing, which is one time dosing daily, will increase adherence in patients with COPD. As a result, adherence between both long-acting and regular were similar. LAMA was seen to have a very high adherence compared to twice daily dosing, but there was no evidence that showed that twice daily dose caused lower adherence.

This study was short but it’s an evidence towards something that pharmacists have been looking for in patients. Pharmacists role in the community is to help improve the adherence of patients medications with the right guidance and understand the community. This research studied proved that the difference between LAMA and twice daily dose was very similar, even though there was evidence that LAMA had higher adherence. This does not show particularly that patients should switch to one time dosing. Rather, this shows that the adherence comes from patients understanding as these patients in the research study were well explained about their use of anticholinergic for COPD. Would counseling every patient on how to use the medication and following up on the medication, help improve adherence for both LAMA and twice-daily dosing?


Izquierdo, J. L., Paredero, J. M., & Piedra, R. (2016). Relevance of dosage in adherence to treatment with long-acting anticholinergics in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease, 11, 289–293.