Welcome to the Peers in Practice inhale hub. Here you will find information to support your COPD consultations with your patients
Adverse events reporting and prescribing information can be found at the bottom of the page.
This material was developed in collaboration with a UCL Business company, Personia Health, industry leaders in the application of validated behavioural science frameworks and tools developed from extensive research into helping patients and healthcare professionals to get the best from treatments by enhancing engagement, adherence and persistence to optimise health.1
Healthcare professionals have been consulted by GSK and received honorarium.
Understanding
Behavioural Change
Patients don’t just need instructions, they need understanding. Their motivation hinges on why a treatment matters to them versus what worries it raises.
Tackle both perceptual and practical barriers to boost adherence and outcomes.2
Read on to find out more
Addressing barriers to facilitate new healthy habits in patients
When patients struggle to change their inhaler routine, it’s rarely for just one reason.
Let’s take non-adherence to a different inhaler as an example. In most cases, non-adherence comes down to one of two things:
they don’t feel motivated to change, or they don’t feel able to.2
A lack of motivation reflects a perceptual barrier — how the patient thinks or feels about the treatment.
A lack of ability to adhere reflects a practical barrier — what gets in the way of acting day to day.
To support meaningful behaviour change, both need to be addressed.
The Perceptions and Practicalities Approach (PAPA™) provides a simple way to structure patient discussions around these two barriers, helping clinicians understand what’s driving resistance to change and where support is most needed.2
A patient discussion works best when it focuses on two things2
Increase motivation by exploring:
Necessity
What matters to the patient and why the treatment feels important to them.
Concerns
Worries or doubts about taking the treatment, now or long term.
Increase ability by exploring:
Practicalities
How easy is it for the patient to make the change and fit into daily life.
Knowledge
The patient’s understanding of how and when to use their treatment.
See motivational interviewing in practice
Learn how Dr Beverley Bostock uses motivational interviewing to support patient-centred consultations.
Who is Dr Beverley Bostock?
Adverse events reporting and prescribing information can be found at the bottom of the page.
How patient beliefs shape treatment decisions
Patients don’t think about treatments in abstract terms.They form beliefs about each medication based on their own experiences, expectations, and concerns.
Even when there are significant differences in clinical outcomes, a patient may accept one inhaler yet feel hesitant about another. This hesitation often reflects how necessary the treatment feels to them, weighed against any worries about taking it.
The Necessity–Concerns Framework (NCF™) helps explain how these beliefs shape motivation
to start and continue treatment.3
When concerns outweigh perceived need, adherence is more likely to suffer.
Understanding this balance can help clinicians uncover what’s driving resistance to change and guide more effective, patient-centred discussions.2,3
“I understand the medicine you’re offering is effective, but I don’t want to switch from my current inhaler.”
Not a real patient.
For illustrative
purposes only.
Necessity
Do I really need this?
How important this treatment feels to the patient
Does it help them achieve something that matters to them?
Concerns
What worries me about taking it?
Worries or doubts about taking the treatment
Including side effects or long-term concerns
Do I really need this?
How important this treatment feels to the patient
Does it help them achieve something that matters to them?
What worries me about taking it?
Worries or doubts about taking the treatment
Including side effects or long-term concerns
When nudging can help — and when it can't
Nudging involves small changes in how choices are presented to make a behaviour easier — without removing choice.
In COPD care, nudges can support patients who are already open to change but may need help following through, such as linking a new inhaler routine to an existing habit.
However, nudging is not effective for everyone. If a patient has strong concerns or does not feel the treatment change is necessary, nudging alone may undermine trust rather than support change.4,5
See nudging in practice
Discover how Dr Beverley Bostock uses nudging techniques to guide patient treatment decisions.
Who is Dr Beverley Bostock?
Optimising the Patient Discussion
Every interaction matters.
Help amplify each one.
Abbreviations
ARNS, Association of Respiratory Nurse Specialists; COPD, chronic obstructive pulmonary disease; NICE, National Institute for Health and Care Excellence; PCRS, Primary Care Respiratory Society.
References
- Personia Health, a University College London Business company - making the most of medicines and vaccines. Available at: https://personiahealth.com
- Horne R, et al. Eur Psychol. 2019:24(1):82-96.
- Horne R, et al. PLoS One. 2013;8(12):e80633.
- Thaler RH, et al. Penguin. 2009.
- Kiener M. Philos Study. 2021;178(12):4201-26.
March 2026 | PM-GB-CPU-WCNT-240005 (V2.0)
For the Trelegy Ellipta® (fluticasone furoate/umeclidinium/vilanterol) prescribing information Click here.
Beverley is an Advanced Nurse Practitioner in Gloucestershire and an independent prescriber. She is the Asthma Lead for ARNS, Chair of the ARNS Respiratory Diseases committee, and sits on the Executive Committee of the PCRS and Asthma and Lung UK's Council of Healthcare Professionals. She holds an MSc in Respiratory Care and an MA in Medical Ethics and Law. Bev was part of the NICE Asthma Quality Standards development and the National Review of Asthma Deaths. She is Editor in Chief of Practice Nurse Journal and has been a Queen’s Nurse since 2015.
