Asthma and COPD medicines prescription-claims: A time-series analysis of England’s national prescriptions during the COVID-19 pandemic (Jan 2019 to Oct 2020)

Abstract

Background: During the pandemic, there have been disruptions to how patients seek care. Research design and methods: To investigate monthly prescription claims for asthma and chronic obstructive pulmonary disease (COPD) medicines during the first UK wave, interrupted time series (ITS) analysis was used. A national cohort of community patients' data were examined. Results: Descriptive statistics show salbutamol, aminophylline, ipratropium, and theophylline remain below pre-pandemic levels. Montelukast showed pre-pandemic monthly increase (Est. 67,151 doses, P = 0.05, 95% CI: 1011, 133,291), followed by a jump of 1.6 million doses at March , followed by monthly declines (Est. −112,098 doses, P = 0.216, 95% CI: -293,499, 69,303). Before the pandemic, tiotropium, salbutamol, aminophylline, and ipratropium (P = 0.003) show monthly declines but theophylline and beclometasone showed increases. In March , salbutamol (P = 0.033) and ipratropium (P = 0.001) show a significant jump. After March , ipratropium continues with a downward trajectory (P = 0.001), with a generalized negative trend for all other agents. Salbutamol confidence bounds become negative after March 2020. Some brands were unavailable. Conclusions: An 'unmet' medical gap is identified. While it is essential to understand the underlying reasons, urgent action needs to be taken to reassess patients and ensure continuity of care.

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

“… 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. Even if the observed reductions were due to improved self-management including high medication adherence during the pandemic, more plausible underlying factors are the various non-pharmacological interventions during the pandemic that led to reduced social interactions and the associated reduced risks of contracting viral infections.…”

Impact of the COVID-19 pandemic on cardiovascular heart disease medication use: time-series analysis of England’s prescription data during the COVID-19 pandemic (January 2019 to October 2020)

“…An interrupted time-series (ITS) design 43 – 45 at 95% confidence level was used, which provides powerful evidence of causal effects because it controls for secular trends in study outcomes. The Cochrane Resources 43 form the ‘benchmark’ methodology for this study, and others have previously used the Box–Jenkins techniques 21 , 22 , 23 , 25 , 26 , 46 – 50 described here. A commonly used time-series modelling framework [autoregressive integrated moving average (ARIMA)] to analyse the monthly total quantity of prescription data from the EPD was employed.…”

“…Not much is known about rates of cardiovascular events in ambulatory patients during the COVID-19 pandemic, nor rates of CVD drug adherence during the lockdown. However, recent evidence is emerging from the United Kingdom that plausibly connects the onset and course of the pandemic to temporal changes in drug series [21][22][23][24] [for gonadorelins, calcineurin inhibitors, asthma and chronic obstructive pulmonary disease (COPD) medicines, and anticoagulants], trends that are being observed globally, providing an early signal for some form of system fragility or system failure with reduced prescription drug coverage. 25,26 Normal clinical practice Patients with long-term routine chronic conditions such as hypertension and related cardiovascular conditions are on routine repeat medication prescriptions in normal clinical practice.…”

Medication adherence in Medicare-enrolled older adults with asthma and chronic obstructive pulmonary disease before and during COVID-19 pandemic

“…14 During the beginning of the COVID-19 pandemic, access to health care was limited, especially for people with hearing, vision, cognition, and mobility disabilities, 15 which are common comorbidities in older adults. Ravina Barrett and Robert Barrett 16 found the prescription claims for the treatment of asthma and COPD were lower than pre-pandemic period using data from English Prescribing Dataset. Our previous studies also showed significant decrease in medication adherence in Medicare-enrolled seniors with asthma or COPD alone during the pandemic compared to pre-pandemic period.…”