In 1994, the results of the first Lung Health Study were
published.1– The study was noteworthy for several of its
findings. Most important, the study showed that the regular
administration of inhaled bronchodilator neither accelerated nor slowed
the rate of lung function decline seen in susceptible smokers. As had
been suggested before, the only effective way to slow the rate of lung
function decline in smokers is to convince them to become nonsmokers.
But the Lung Health Study was also the first large study of respiratory
care to demonstrate what appears to be a widespread phenomenon among
our patients: “dose dumping.” A subset of Lung Health Study
participants participated in a study of their compliance with scheduled
inhaled medication.2 The patients in this substudy were
given inhalers equipped with Nebulizer Chronologs (Medtrac
Technologies; Lakewood, CO), devices that measured not only how often
they actuated their MDI canisters, but exactly when they did so.
Unaware that the devices recorded the date and time of actuations but
knowing that medication usage was being monitored, 14% of patients
repeatedly actuated their canisters (sometimes up to 100 times
successively) so as to give the appearance of complying with the
recommended therapy. Although most physicians recognize that patient
noncompliance is common in chronic disease settings, few would have
anticipated the length to which patients will go to conceal their
noncompliance (or to be more politically correct, their nonadherence).