Zhou Guiling, Mommers Irene, Schuilinga-Veninga Catharina C M, Bos Jens H J, Oude Rengerink Katrien, Pasmooij Anna Maria Gerdina, Mol Peter G M, van Baarle Debbie, de Bock Geertruida H, van Boven Job F M, Hak Eelko
Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Dutch Medicines Evaluation Board, Utrecht, The Netherlands.
Clin Epidemiol. 2025 Apr 9;17:337-352. doi: 10.2147/CLEP.S496841. eCollection 2025.
The impact of the coronavirus disease 2019 (COVID-19) pandemic on asthma medication trajectories, including changes in medication type or dosage, remains unclear. This study compared dispensing patterns among adults who initiated asthma inhalers before pandemic (cohorts 2014 and 2017) and during pandemic (cohort 2020).
We performed retrospective inception cohort study using University of Groningen IADB.nl community pharmacy dispensing database. Individuals aged 16-44 years who initiated inhaled asthma treatment in 2014, 2017, or 2020 were followed for 2 years. Treatment steps (1-5) were based on the Global Initiative for Asthma (GINA) guideline. Primary outcomes included time to treatment step switch (step-up or step-down) and time to first oral prednisolone/prednisone, and were compared between cohorts using Cox regression models.
In 2014, 2017 and 2020, 1193, 960 and 730 patients initiated asthma inhalers, respectively. In all cohorts, more than half of the patients initiated treatment at the lowest step. During 2-year follow-up, fewer patients switched their treatment steps in 2020 when compared with 2014 (adjusted hazard ratio (aHR): 0.86 (95% confidence interval (CI): 0.76-0.99). From 2014 to 2020, the likelihood of treatment stepping-down decreased over time, with a 21% in 2017 (aHR: 0.79 (0.68-0.92)) and 24% in 2020 (aHR: 0.76 (0.64-0.90)) compared to 2014, while the likelihood of stepping-up did not change significantly. The risk of taking oral prednisolone/prednisone was also significantly lower in 2020 (aHR: 0.76 (0.61-0.94)).
During the pandemic, fewer asthma patients switched treatment steps and took oral prednisolone/prednisone. Since 2014, fewer individuals stepping down medication, with a decrease of 21% in 2017 and 24% in 2020. Possible drivers include improved adherence, better asthma control, and increased telemedicine use-trends that predate and have been accelerated by the pandemic. Research incorporating clinical data is necessary to confirm these hypotheses.
2019冠状病毒病（COVID-19）大流行对哮喘药物治疗轨迹的影响，包括药物类型或剂量的变化，仍不明确。本研究比较了在大流行前（2014年和2017年队列）和大流行期间（2020年队列）开始使用哮喘吸入器的成年人的配药模式。
我们使用格罗宁根大学IADB.nl社区药房配药数据库进行了回顾性队列研究。对2014年、2017年或2020年开始吸入性哮喘治疗的16 - 44岁个体进行了2年的随访。治疗步骤（1 - 5级）基于全球哮喘防治创议（GINA）指南。主要结局包括治疗步骤转换时间（升级或降级）和首次使用口服泼尼松龙/泼尼松的时间，并使用Cox回归模型在各队列之间进行比较。
2014年、2017年和2020年分别有1193例、960例和730例患者开始使用哮喘吸入器。在所有队列中，超过一半的患者从最低级别开始治疗。在2年的随访期间，与2014年相比，2020年转换治疗步骤的患者更少（调整后风险比（aHR）：0.86（95%置信区间（CI）：0.76 - 0.99））。从2014年到2020年，治疗降级的可能性随时间下降，2017年为21%（aHR：0.79（0.68 - 0.92）），2020年为24%（aHR：0.76（0.64 - 0.90）），而升级的可能性没有显著变化。2020年使用口服泼尼松龙/泼尼松的风险也显著降低（aHR：0.76（0.61 - 0.94））。
在大流行期间，哮喘患者转换治疗步骤和使用口服泼尼松龙/泼尼松的情况较少。自2014年以来，减少用药剂量的个体减少，2017年减少了21%，2020年减少了24%。可能的驱动因素包括依从性提高、哮喘控制改善以及远程医疗使用增加——这些趋势在大流行之前就已存在并因大流行而加速。纳入临床数据的研究对于证实这些假设是必要的。
