Background The COVID-19 pandemic has witnessed a reduction in asthma exacerbations across the UK. Several factors may underpin this, including reduced transmission of seasonal viruses and improved adherence to inhaled corticosteroids (ICS). However, little is known about how ICS use has changed during the pandemic. Objective To identify prescribing patterns for asthmatics during the pandemic. Methods Using the OpenPrescribing database, we retrospectively analysed prescribing patterns of ICS, salbutamol and peak flow meters from January 2019 to January 2021 across England. Additionally, using a sample asthma cohort at 3 primary care practices in London, we assessed individual prescription patterns. Results A sharp increase in national ICS prescriptions occurred in March 2020 representing a 49.9% increase compared to February 2020. The sample cohort included 1132 patients (762 ICS treated across both years). Overall ICS adherence improved in 2020 ( P <0.001), with the proportion of patients meeting ‘good adherence’ (≥75%) increasing from 33.9% to 42.0% ( P <0.001). The March 2020 spike predominantly reflected improved adherence rather than a hoarding effect of multiple inhalers. Female gender and increasing age was associated with the most significant improvements in adherence. A similar spike in salbutamol occurred in March 2020, however, an overall reduction in salbutamol prescriptions occurred in 2020 ( P =0.039). National figures highlighted a progressive increase in prescription of peak flow meters over 2020. Conclusion ICS adherence rates remain low, however, a modest improvement in adherence was observed during the first year of the COVID-19 pandemic. Salbutamol prescription rates reduced over the same time-period whilst prescriptions for peak flow meters has steadily increased.

Infrequent use of inhaled corticosteroids (ICS) and/or over-reliance of short-acting β-agonists (SABA) are recognised as key contributors to increased morbidity and mortality in asthma. The most frequent measures of ICS adherence and SABA use rely on patient-reported questionnaires or prescription refill records, neither of which are considered sufficiently reliable. Technological advancements in the development of electronic monitoring of inhaler devices allow for monitoring of use, as well as recording of and feedback on inhaler technique for some devices. Most electronic monitoring devices (EMDs) are paired with a smartphone application, allowing patients to set reminders and display both preventer and reliever use over time. This allows identification of intentional and unintentional ICS non-adherence as well as frequency of SABA use. This information assists clinicians in distinguishing difficult-to-control from severe asthma. Although additional evidence is required to assess the impact of EMDs on clinical outcome measures such as exacerbation rate, the introduction of EMDs into the asthma armoury is a significant step forward in asthma care with the potential to improve asthma-related outcomes.

Asthma is defined as a chronic inflammatory disorder of the airways associated with an increase in airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing (particularly at night). When control is achieved, patients can avoid these symptoms, exacerbations, side effects of treatment and lead an active life. The fundamental components to achieving this is adherence to inhaled therapies, optimising inhaler technique and engaging the patient in self-management.