High Anxiety in COPD : A Barrier to Effective Inhaler Medication Adherence and Disease Management

AIMS AND OBJECTIVE: To explore the heterogeneity of disease-specific anxiety profiles among patients with chronic obstructive pulmonary disease (COPD) using latent profile analysis (LPA), and to identify the associations between distinct anxiety subtypes and inhaler medication adherence in patients with COPD. BACKGROUND: Adherence to inhaled medication among patients with COPD continues to be suboptimal. Anxiety, a common comorbidity, may exacerbate this issue. However, the specific relationship between anxiety and adherence to inhaled medications remains unclear. DESIGN: A prospective cohort study was conducted following the STROBE Checklist. METHODS: A prospective observational study employed the Anxiety Inventory for Respiratory Disease (AIR) to assess disease-specific anxiety in patients with COPD. Inhaler medication adherence was evaluated using the Test of Adherence to Inhalers (TAI) 6 months after initiating treatment. Latent Profile Analysis (LPA) was performed to identify distinct anxiety subtypes. Multiple linear regression analysis was conducted to examine the associations between identified anxiety subtypes and adherence dimensions, adjusting for sociodemographic and clinical variables. RESULTS: Among 298 COPD patients, the overall AIR score was 5 (IQR: 2-11). Using LPA, three distinct anxiety subtypes were identified: Low Anxiety-Irritable Subtype (57.05%), Moderate Anxiety-Tense Subtype (26.85%) and High Anxiety-Anticipatory Subtype (16.10%). Through multiple linear regression analysis, the High Anxiety-Anticipatory Subtype was significantly associated with lower inhaler medication adherence among COPD patients. CONCLUSION: This study revealed three latent profiles of disease-specific anxiety among COPD patients. The High Anxiety-Anticipatory Subtype was associated with a lower inhaler medication adherence in individuals with COPD after initiating treatment. RELEVANCE TO CLINICAL PRACTICE: Identifying the relationship between disease-specific anxiety and inhaler medication adherence in patients with COPD after initiating treatment underscores the need for healthcare providers to assess anxiety during patient visits and prioritise patients with high anticipatory anxiety. When high anxiety adversely affects inhaler medication adherence, targeted interventions should be developed to improve adherence and prognosis. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.