touchRESPIRATORY coverage of ATS 2025:
Medication non-adherence is a persistent challenge in the management of COPD, contributing to frequent exacerbations and poor clinical outcomes, prompting investigation into whether digital interventions can offer a scalable solution to improve adherence and long-term health in routine primary care. In this interview, Prof. David Price (Observational and Pragmatic Research Institute [OPRI], Singapore; University of Aberdeen, Aberdeen, UK) and Prof. David Halpin (OPRI, Singapore; University of Exeter, Exeter, UK) discuss the aims and design of the MAGNIFY trial, the algorithm for patient selection, the digital adherence support package given during the trial, and the clinical outcomes in a real-world primary care setting.
The abstract “Offering Digital Adherence Support Improves Clinical Outcomes for High-Risk Chronic Obstructive Pulmonary Disease (COPD) Patients With Poor Adherence to Inhaled Therapy.” was presented at ATS 2025 International Conference, San Francisco, 16–21. May.
Questions
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- What outcomes are associated with poor adherence in COPD? (0:25)
- What were the aims and design of the MAGNIFY trial? (1:53)
- How did the EMR-driven algorithm help identify high-risk COPD patients, and why was that important? (3:28)
- Could you describe the digital adherence support package given to patients during the trial? (4:46)
- What were the findings of the study and what impact will they have on clinical practice? (7:14)
Transcript
Q1. What outcomes are associated with poor adherence in COPD? (0:25)
David Price: As part of doing this project, we’ve actually had a careful look at some of the associations between poor adherence and poor outcomes, and they are strongly there. So that’s both exacerbations of COPD as well as needs to increase therapy, so there clearly is quite a strong association. Also, one of the things we did see is that in people with high-risk COPD, many of them are not adherent to their background therapies, so we tend to be increasing treatment without really making sure people are taking things. So, that’s certainly quite an association.
David Halpin: It makes sense if you don’t take the medication, you’re not likely to get the benefits. That’s an assumption. But there are some very good data where adherence has actually been monitored using electronic devices similar to the one that we used in this study, which have shown that poor adherence, particularly if combined with poor technique as well, is associated with increased exacerbations, but also increased mortality from COPD. So this isn’t a trivial event and, as David said, non-adherence across the board or poor adherence is very common. Maybe 50% of patients are not taking medication as regularly as they should do.
Q2. What were the aims and design of the MAGNIFY trial? (1:53)
David Halpin: The MAGNIFY study was designed to see whether a support package, and it’s important to emphasize that it’s a package not just the electronic device, to see if you supported patients who were at risk of poor outcomes, whether giving them or offering them this support package in a real world setting could improve outcomes.
David Price: We were really trying very hard to understand if you have something like this available to clinicians, whether choosing to give it to the right patients and identifying the right patients actually makes a difference in real life.
David Halpin: I think a challenge there is how do you identify those patients? So we went for a group where we thought we were likely to see the biggest benefits, so those at highest risk of future exacerbations; in other words, people who’ve had previous exacerbations. And we used a tool to scan the patient records to identify those patients who are at greatest risk. So I think that’s the first point.
The other challenge in doing a study like MAGNIFY is this sense of contamination. So if you do an RCT in a conventional way, where you take individual practices, recruit patients, some of whom go on to the intervention and some of whom don’t – within the practice, there is knowledge about the intervention. There’s a different attitude towards adherence, perhaps more attention to adherence. So we use the cluster randomized design to overcome the bias that would be introduced if it was done within individual practices.
Q3. How did the EMR-driven algorithm help identify high-risk COPD patients, and why was that important? (3:28)
David Price: We were very keen to make sure that we had the people who were going to get the biggest benefit. Often in clinical trials, you have patients who are volunteering for studies and so it’s actually quite hard to think about who’s at genuine risk, and they’re often hiding in primary care too. So by examining the patient’s electronic medical records, not just for the last year, but actually over several years, you can establish people’s risk profiles. In fact, we uniquely here, we looked at two things; we looked at people who were recently having flare ups or people who further ago because of COVID, so pre-2024, had flare ups then. So we were able to look at that from their electronic medical records and establish who’s high risk.
David Halpin: I think it shows that one of the added values of electronic records is that this was done as part of the research study by the research team, but practices themselves could run these sort of algorithms and identify patients who need that extra attention in routine clinical care as well. So I think there are some spin-offs in that way.
Q4. Could you describe the digital adherence support package given to patients during the trial? (4:46)
David Halpin: The package was really two main components. One was that once patients had been identified, they had an interview with a pharmacist who ran through issues about medication adherence, explored patients’ attitudes, and explained to patients perhaps what the medication was there for. I think, all too often, medication is prescribed to patients without any explanation of what benefits they should be getting from it and how important it is to take regularly. So, that intervention happened just at the start, and we know from other studies that when you do something like that, the benefits decay over time. So after 3 or 6 months, the benefit of that particular intervention has probably disappeared, but we backed that up with this electronic device.
It is a clip-on device that adds on to the inhaler that is able to monitor the usage of the device, the timing, and whether it was used correctly. It had a microphone that could listen to the noise generated by the inhalation. That information was provided just to the patients on a smartphone app, so they got reminders as to when they should take the medication, and they could get summary data of how regularly they’ve been taking their medication over time. The app also had some educational components for the patient about managing their disease, why the medication was important, and what it was doing, etc.
Some of that information was fed back or practices had the option to view that data for the patients and potentially intervene if they saw that a patient was not taking it regularly. As part of the study, we had no knowledge of that; that was just between the practice and the patient. So, it’s really that the package was the intervention by the pharmacist backed up, and hopefully, the device would then sustain the behaviour and reinforce the behaviour that the pharmacist was encouraging.
David Price: But just to emphasize that this was really under patient control, so this is their app and their data. So we were not supervising that in any shape or form. So we tried to set it out just as it would be made available to them in clinical practice, rather than exceptional clinical practice. The only exceptional clinical practice was finding the right patients for it.
Q5. What were the findings of the study and what impact will they have on clinical practice? (7:14)
David Halpin: Our primary endpoint was a composite of what we call treatment failure, and there were three components to treatment failure. One was an exacerbation, so the patient, despite what we’ve done, had a moderate or severe exacerbation. The second was the requirement for additional medication and so within COPD management, having to step patients up to a higher level of treatment, which brings with it the risk of additional side effects, is a poor outcome. So trying to keep them on their current medication and benefiting from that is important. So treatment escalation was the second component. Then the final one was obviously death and fortunately, there weren’t many deaths in the study. What we showed was that in those patients that were in practices that’d been offered the adherence support package, the risk of treatment failure was 23% less than the patients that were in control practices.
David Price: Treatment success was designed particularly to cope with the fact that during COVID, we were less likely to see exacerbations. So many people were not getting the virus exposure. So we were looking at markers that would reflect in real life that disease was not doing so well. So that was when going back and seeing your doctor and getting an increase in therapy was one of the big markers included within that, as well as flare ups of the disease.
David Halpin: I think going back to your question about the implications for clinical practice, escalation to additional inhaled therapy or oral therapy brings side effects. In a world now where we’re moving into very expensive biologic therapies, that would be the next step for many of these patients – if you can maintain their health, keep them without the need to escalate to biologic therapy. From a health system perspective, that’s very good and it’s a lot more cost effective. From a patient’s point of view, if they can be managed with a simple inhaler, it’s a lot better than having to have injections.
David Price: That’s the point about adherence and that’s something that never really happened in the asthma space, probably because we didn’t have the tools. You know, it’s that everyone’s been accelerated to biologics, which for many of them has been fantastic, but we’ve got an even bigger problem of high-risk disease in COPD than we have in asthma. So being able to really understand what’s going on with people’s adherence and helping them to manage that is very important.
Subtitles and transcript are autogenerated.
Further content in COPD.
This content has been developed independently by Touch Medical Media for touchRESPIRATORY. It is not affiliated with the American Thoracic Society (ATS). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Editor: Victoria Smith, Senior Content Editor.
Cite: David Price and David Halpin. Improved COPD Outcomes with a Digital Adherence Support Package: Findings from MAGNIFY. touchRESPIRATORY. July 2025.
Abstract: Price DB, Dickens AP, Henley W, et al. Offering Digital Adherence Support Improves Clinical Outcomes for High-Risk Chronic Obstructive Pulmonary Disease (COPD) Patients With Poor Adherence to Inhaled Therapy. Am J Respir Crit Care Med. 2025;211:A1336.
Disclosures: This short article was prepared by touchRESPIRATORY in collaboration with David Price and David Halpin. touchRESPIRATORY utilize AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No fees or funding were associated with its publication.
David Price discloses receiving grant/research support from: AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals, investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Chiesi, Viatris, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and UK National Health Service; serving on advisory boards for: AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, and Teva Pharmaceuticals; participating in Speaker’s Bureau with payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Inside Practice, GlaxoSmithKline, Medscape, Viatris, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and Teva Pharmaceuticals; being a major stock/shareholder in: the social enterprise Optimum Patient Care Ltd (Australia and UK) and Observational and Pragmatic Research Institute Pte Ltd (Singapore); and receiving travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Novartis, Medscape, and Teva Pharmaceuticals. David Halpin discloses consulting for, serving on advisory boards for, and participating in speaker’s bureaus for: AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Pfizer.
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