Improved COPD Epidemiological Awareness Following Standardized Education Independently Associated with Better Inhaled Medication Adherence: A Multicenter Prospective Pre-Post Study
- 1Department of Respiratory and Critical Care Medicine
- 2Department of Chronic Respiratory Disease Management and Rehabilitation Center
Abstract
Qiao Zhang,1,* Qinqin Wang,2,3,* Lingjun Liu,2,3 Hong Li,2,3 Xiuqing Liao,4 Qianli Ma2,3 1Department of Respiratory and Critical Care Medicine, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 2Department of Chronic Respiratory Disease Management and Rehabilitation Center, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 3Department of Allergy and Immunology, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qianli Ma, Department of Chronic Respiratory Disease Management and Rehabilitation Center, Chongqing Songshan General Hospital, 69 Xingguang Avenue, Yubei District, Chongqing, People’s Republic of China, Email [email protected]: Chronic obstructive pulmonary disease (COPD) contributes substantially to global morbidity and mortality, while suboptimal inhaled medication adherence worsens clinical outcomes. Existing evidence confirms disease knowledge shapes self-medication behaviors, yet it remains unclear which distinct COPD knowledge domains correlate with adherence improvements following standardized patient education.Objective: To explore associations between changes in each domain of COPD-related knowledge and variations in inhaled medication adherence following routine outpatient standardized health education.Design and Participants: This was a multicenter, prospective, observational pre–post study. Consecutive stable COPD outpatients aged ≥ 40 years were recruited between June 2024 and June 2025 from two tertiary hospitals in Chongqing, China.Methods: All participants received 30-minute standardized education covering all 13 knowledge subdomains of the Bristol COPD Knowledge Questionnaire (BCKQ). BCKQ, Medication Adherence Report Scale (MARS), and COPD Assessment Test (CAT) were administered at baseline and 3-month follow-up. Spearman correlation and ANCOVA with Holm-Bonferroni correction were used; two supplementary sensitivity models were applied to verify result stability.Results: A total of 894 patients were included in the final analysis. Scores of the total BCKQ, MARS, and CAT all showed statistically significant changes after education (all P < 0.001). Among all 13 knowledge subdomains, only increased epidemiological knowledge scores were positively correlated with improved inhaled medication adherence (ρ = 0.43, P < 0.001). After adjusting for baseline adherence, total baseline knowledge and multiple demographic/clinical confounders, elevated epidemiological knowledge was independently associated with higher follow-up MARS scores (B = 0.33, SE = 0.04, P < 0.001). Consistent statistical significance for ΔEpidemiology was observed across two sensitivity analytical models. Baseline low adherence was 64.0%, and medication-related knowledge gains were not associated with adherence change.Conclusion: Improvements in COPD epidemiological knowledge were independently associated with greater inhaled medication adherence after standardized outpatient education. Prioritizing education on disease progression and long-term threats may be an effective strategy to optimize adherence in busy clinical settings.Keywords: chronic obstructive pulmonary disease, inhaled medication adherence, health education, disease knowledge, patient self-management
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BibTeX
@article{zhang2026improved,
title = {{Improved COPD Epidemiological Awareness Following Standardized Education Independently Associated with Better Inhaled Medication Adherence: A Multicenter Prospective Pre-Post Study}},
author = {Zhang Q and Wang Q and Liu L and Li H and Liao X and Ma Q},
journal = {International Journal of COPD},
year = {2026},
month = nov,
url = {https://www.dovepress.com/improved-copd-epidemiological-awareness-following-standardized-educati-peer-reviewed-fulltext-article-COPD},
note = {CC BY},
}
RIS
TY - JOUR
TI - Improved COPD Epidemiological Awareness Following Standardized Education Independently Associated with Better Inhaled Medication Adherence: A Multicenter Prospective Pre-Post Study
AU - Zhang Q
AU - Wang Q
AU - Liu L
AU - Li H
AU - Liao X
AU - Ma Q
PY - 2026
DA - 2026/11/08
JO - International Journal of COPD
UR - https://www.dovepress.com/improved-copd-epidemiological-awareness-following-standardized-educati-peer-reviewed-fulltext-article-COPD
AB - Qiao Zhang,1,* Qinqin Wang,2,3,* Lingjun Liu,2,3 Hong Li,2,3 Xiuqing Liao,4 Qianli Ma2,3 1Department of Respiratory and Critical Care Medicine, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 2Department of Chronic Respiratory Disease Management and Rehabilitation Center, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 3Department of Allergy and Immunology, Chongqing Songshan General Hospital, Chongqing, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qianli Ma, Department of Chronic Respiratory Disease Management and Rehabilitation Center, Chongqing Songshan General Hospital, 69 Xingguang Avenue, Yubei District, Chongqing, People’s Republic of China, Email [email protected]: Chronic obstructive pulmonary disease (COPD) contributes substantially to global morbidity and mortality, while suboptimal inhaled medication adherence worsens clinical outcomes. Existing evidence confirms disease knowledge shapes self-medication behaviors, yet it remains unclear which distinct COPD knowledge domains correlate with adherence improvements following standardized patient education.Objective: To explore associations between changes in each domain of COPD-related knowledge and variations in inhaled medication adherence following routine outpatient standardized health education.Design and Participants: This was a multicenter, prospective, observational pre–post study. Consecutive stable COPD outpatients aged ≥ 40 years were recruited between June 2024 and June 2025 from two tertiary hospitals in Chongqing, China.Methods: All participants received 30-minute standardized education covering all 13 knowledge subdomains of the Bristol COPD Knowledge Questionnaire (BCKQ). BCKQ, Medication Adherence Report Scale (MARS), and COPD Assessment Test (CAT) were administered at baseline and 3-month follow-up. Spearman correlation and ANCOVA with Holm-Bonferroni correction were used; two supplementary sensitivity models were applied to verify result stability.Results: A total of 894 patients were included in the final analysis. Scores of the total BCKQ, MARS, and CAT all showed statistically significant changes after education (all P < 0.001). Among all 13 knowledge subdomains, only increased epidemiological knowledge scores were positively correlated with improved inhaled medication adherence (ρ = 0.43, P < 0.001). After adjusting for baseline adherence, total baseline knowledge and multiple demographic/clinical confounders, elevated epidemiological knowledge was independently associated with higher follow-up MARS scores (B = 0.33, SE = 0.04, P < 0.001). Consistent statistical significance for ΔEpidemiology was observed across two sensitivity analytical models. Baseline low adherence was 64.0%, and medication-related knowledge gains were not associated with adherence change.Conclusion: Improvements in COPD epidemiological knowledge were independently associated with greater inhaled medication adherence after standardized outpatient education. Prioritizing education on disease progression and long-term threats may be an effective strategy to optimize adherence in busy clinical settings.Keywords: chronic obstructive pulmonary disease, inhaled medication adherence, health education, disease knowledge, patient self-management
SN - 1178-2005
SN - 1176-9106
ER -