• Kirsten Koehorst-Ter Huurne, Marjolein Brusse-Keizer, Paul van der Valk, Kris Movig, Job van der Palen, and Christina Bode.
• Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands, kirstenterhuurne@gmail.com.
• Patient Prefer Adher. 2018 Jan 1; 12: 1777-1783.

BackgroundTherapy adherence in COPD is crucial for treating symptoms, preventing exacerbations, and related complications. To achieve optimal adherence, it is important to recognize and understand a nonadherent patient.ObjectiveTo study perceptions and beliefs regarding COPD and inhaled medication in COPD patients with poor adherence.MethodsTwenty patients (10 underuse, 10 overuse) were interviewed in semistructured in-depth interviews, about mental and physical health, illness perceptions, knowledge regarding COPD, and experience with, knowledge of, and acceptance of COPD medication and inhalation devices.ResultsA majority of patients did not fully accept their disease, showed little disease knowledge, and many revealed signs of depressive mood and severe fatigue. Overusers reported more grief about decreased participation in daily life and were more frustrated in general. Underusers claimed using less medication because they felt well, did not want to use too much medication, and used their inhalation devices too long. Overusers reported medication "dependency"; they tended to catastrophize when being without medication and discarded inhalation devices too early because they feared running out of medication.ConclusionOverusers and underusers showed a different pattern in perceptions and beliefs regarding inhaled medication and COPD.Practical ImplicationsIt is important to understand the reasons for under- and overuse. Is it related to practical issues regarding knowledge or is it influenced by beliefs and/or anxiety concerning COPD or medication? These issues need to be addressed for improving adherence.

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