Medication noncompliance in patients with chronic obstructive pulmonary disease (COPD), a result of affordability and lack of drug knowledge, among other things, leads to increased exacerbations and a rapid decline in lung function, two new studies have found. This study will be published in the January 2026 issue. Chronic Obstructive Pulmonary Disease: COPD Foundation Journala peer-reviewed open access journal.
COPD, which includes emphysema and chronic bronchitis, affects more than 30 million Americans and is the fourth leading cause of death worldwide. It can be caused by genetics or irritants such as smoke or pollution.
Inhaled medications can help improve symptoms and reduce worsening. However, studies have shown that approximately 43% to 58.7% of people do not take their medications as prescribed by their doctors, leading to higher hospitalization rates and increased mortality.
In the new study, researchers looked at a group of 2,521 participants in the COPD Genetic Epidemiology (COPDGene®) study who completed a socio-economic survey. Cost-related non-compliance was reported by 16.2% (408 participants) of participants. These people either didn’t fill their prescriptions or took less of their medication due to expense or lack of insurance coverage. Of these, 93.5% had some form of health insurance.
Study results showed that those who experienced cost-related defaults had faster declines in lung function, more frequent exacerbations, and greater symptom burden.
Medication nonadherence can be caused by a variety of factors. Cost is an important factor for people with COPD and other chronic lung diseases. Many COPD treatments are brand-name inhalers, which come with high out-of-pocket costs. Broader policy changes are needed to make these medicines more affordable. Two respirators under negotiation in the second round of the Inflation Control Act could help reduce cost-related noncompliance. ”
Rajat Suri, MD, MSc, Department of Respiratory, Critical Care, and Sleep Medicine, University of California, San Diego, and lead author of this study
In another new study, researchers interviewed a small group of participants from a single academic medical center in Chicago. Of the 17 participants, almost half reported not taking their medication as prescribed or using their inhaler incorrectly. Participants cited forgetfulness, physical limitations, limited understanding of how and when to use their inhaler, difficulty accessing care, stigma, and cost as barriers.
“Medication nonadherence is common, but the reasons behind it are highly individualized,” said Stephanie L. Lovedz, MD, PhD, Department of Pulmonary, Critical Care, Sleep, and Allergy at the University of Illinois at Chicago, and lead author of the study. “Doctors need to understand all the barriers that patients face so they can better educate and support them to ensure that medicines are used correctly.”
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Reference magazines:
Suri, R. Others. (2026) Long-term effects of cost-related noncompliance on COPD outcomes and progression in the COPDGene study cohort. COPD Foundation Chronic Obstructive Pulmonary Disease Journal. DOI: 10.15326/jcopdf.2025.0689. https://journal.copdffoundation.org/jcopdf/id/1573/The-Long-Term-Effects-of-Cost-Many-Nonadherence-on-COPD-Outcomes-and-Progression-in-the-COPDGene-Study-Cohort
