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.

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