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Editorials |

Reality-Based Medicine

Kenneth R. Chapman, MD, MSc, FCCP
Author and Funding Information

Affiliations: Toronto, Ontario, Canada 
 ,  Dr. Chapman is Professor of Medicine, University of Toronto.

Correspondence to: Kenneth R. Chapman, MD, FCCP, Asthma Centre University Health Network, Suite 4–011 ECW, 399 Bathurst St, Toronto, Ontario M5T 288, Canada; e-mail: kchapoman@inforamp.net



Chest. 2000;118(2):281-283. doi:10.1378/chest.118.2.281-a
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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).

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