For patients with Chronic Obstructive Pulmonary Disease (COPD) and a co-morbidity of depression, adherence to COPD maintenance medication is particularly low.

Researchers found an association between concomitant depression and a drop in COPD medication adherence to 25%, six months after patients filled their first prescription.

“With a prevalence of 17 to 44%, depression remains one of the most common, yet least recognized and under-treated, co-morbidities among patients with COPD,” said co-author of the study Linda Simoni-Wastila, BSPharm, MSPH, PhD. 

For their analysis, the researchers used Medicare administration claims data from the Centers for Medicare and Medicaid Services Chronic Condition Data Warehouse and selected a random 5% of Medicare beneficiaries from 2006 to 2012. The average age of subjects was 68 years. To be included in the final analysis, subjects had to have 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.

In total, their search resulted in 31,033 subjects meeting criteria. Of these 6,227 (20%) were diagnosed with depression after COPD, as defined by at least 1 diagnosis code on at least 1 in-patient claim, or at least 2 outpatient claims during the study period.

Among patients with depression, COPD adherence peaked at 57% in the month after their first COPD medication fill, and dropped to 35% within 6 months. The adjusted regression model showed that depression was tied to a significant decrease in COPD maintenance medication adherence (OR 0.93%; 95% CI 0.89, 0.98).

“Clinicians who treat older adults newly-diagnosed with COPD should be aware of the development of depression, especially during the first six months,” said Simoni-Wastila. The author’s also stated their hope that their analysis will help policymakers, practitioners, and patients think holistically about how 1 condition affects how another condition progresses and is managed.

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