Kim Hyungmin, Kim Hyunduck, Yoon Yookyung, Hong Song Hee
College of Pharmacy, Seoul National University, Seoul 08826, Republic of Korea.
National Health Insurance Service, Wonju 26464, Republic of Korea.
Healthcare (Basel). 2025 Jun 15;13(12):1431. doi: 10.3390/healthcare13121431.
The outbreak of coronavirus disease 2019 (COVID-19) has restricted access to healthcare, increasing the risk of poor disease control among patients with COPD (Chronic Obstructive Pulmonary Disease). This study aimed to compare adherence to inhalers in patients with COPD before and during the COVID-19 lockdown and determine the characteristics of patients who were adherent to inhaler medications. A retrospective analysis was conducted on a cohort of patients with severe COPD aged 40 or older using South Korea's National Health Insurance Service (NHIS) database, which documents all healthcare utilization covered for insured individuals. Medication adherence, measured by the proportion of days covered (PDC), was compared before and during the COVID-19 lockdown using a paired t-test. A multivariable logistic regression model was conducted to identify the characteristics of the adherent patients (socio-demographic, including age, sex, income level, insurance type, and residential area), health-conditions (disease severity, underlying diseases, and disability), and pharmacotherapy characteristics (prescriber practice setting, polypharmacy, medication treatment duration, and inhaler type). A total of 15,971 COPD patients were identified (79.2% men). During the COVID-19 lockdown in 2020, there was a significant decrease in medication adherence to COPD inhalers compared to 2019 (49.8% in 2020 vs. 56.3% in 2019, respectively; < 0.001). Moreover, the proportion of those adherent (≥80%) during the COVID-19 lockdown decreased (22.0% → 18.0%). Patients who remained adherent to inhaler therapy during the COVID-19 lockdown were typically aged in their 60s, beneficiaries of Medical Aid, residents of rural areas, clinic users, and patients without cardiovascular disease. Patients with COPD encountered significant challenges in accessing inhalers during the COVID-19 lockdown. Healthcare authorities should develop targeted strategies to ensure continued medication access for patients at increased risk of poor medication adherence, particularly during periods of restricted healthcare access, such as public health emergencies or pandemic lockdowns.
2019年冠状病毒病（COVID-19）的爆发限制了人们获得医疗保健的机会，增加了慢性阻塞性肺疾病（COPD）患者疾病控制不佳的风险。本研究旨在比较COVID-19封锁前和封锁期间COPD患者吸入器的使用依从性，并确定吸入器药物治疗依从性良好的患者特征。利用韩国国民健康保险服务（NHIS）数据库对一组40岁及以上的重度COPD患者进行了回顾性分析，该数据库记录了参保人员的所有医疗保健使用情况。使用配对t检验比较了COVID-19封锁前和封锁期间以覆盖天数比例（PDC）衡量的药物治疗依从性。进行多变量逻辑回归模型以确定依从性患者的特征（社会人口统计学特征，包括年龄、性别、收入水平、保险类型和居住地区）、健康状况（疾病严重程度、基础疾病和残疾情况）以及药物治疗特征（开处方的医疗机构类型、联合用药情况、药物治疗持续时间和吸入器类型）。共确定了15971例COPD患者（79.2%为男性）。与2019年相比，2020年COVID-19封锁期间COPD吸入器的药物治疗依从性显著下降（2020年为49.8%，2019年为56.3%；P<0.001）。此外，COVID-19封锁期间依从性良好（≥80%）的患者比例下降（22.0%→18.0%）。在COVID-19封锁期间仍坚持吸入器治疗的患者通常为60多岁，是医疗救助的受益者，居住在农村地区，是诊所的使用者，且没有心血管疾病。在COVID-19封锁期间，COPD患者在获取吸入器方面面临重大挑战。医疗保健当局应制定有针对性的策略，以确保药物治疗依从性较差风险增加的患者能够持续获得药物，特别是在医疗保健受限期间，如突发公共卫生事件或大流行封锁期间。
