Prescribing Patterns and Treatment Adherence in Patients with Asthma During the COVID-19 Pandemic

Abstract

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.

Impact of COVID-19 pandemic on asthma exacerbations: Retrospective cohort study of over 500,000 patients in a national English primary care database

“…A recent study from England suggested only a modest increase in adherence to Inhaled Corticosteroids (ICS) medication in the first year of the pandemic primarily driven by increased prescription in March 2020. 31 Another study from England suggests that medication use declined during the first eight months of the pandemic. 32 Studies from the US have also suggested decreased adherence to controller medications amongst patients with asthma for both children 33 and adults 34 during the pandemic.…”

Impact of the COVID-19 Pandemic on Incidence of Asthma Exacerbations and Hospitalizations in US Subspecialist-Treated Patients with Severe Asthma: Results from the CHRONICLE Study

“…28,29 Relatedly, there is some evidence that the reductions in asthma exacerbations observed during the pandemic may also have been partially driven by increased disease awareness and medication adherence. [30][31][32] An analysis of controller inhaler usage among patients with asthma or chronic obstructive pulmonary disease (COPD) found a 14.5% increase in medication adherence from the beginning of January 2020 to the end of March 2020. 31 Patients with asthma may have thought they had a higher risk of contracting severe COVID-19 disease, which could contribute to positive changes in medication adherence.…”

Rhinovirus Infections and Their Roles in Asthma: Etiology and Exacerbations

“…Several factors could explain this, including a fall in urban air pollution levels and/or a change in patient behavior leading to an improvement in adherence to ICSs. 99 However, it is possible that the nonpharmacologic interventions of increased hand washing and mask wearing, aimed at reducing transmission of severe acute respiratory syndrome coronavirus 2, will ultimately prove to be the most effective intervention against seasonal virusinduced asthma exacerbations since the introduction of ICSs almost half a century ago. For example, in New Zealand during the first wave of the pandemic, the usual winter influenza surge was essentially eliminated, with a 99.9% reduction in influenza virus detections, and a 74.6% reduction in RV infections as compared with previous years.…”