Dispensing Patterns of Inhaled Asthma Medication Before and During COVID-19 Among Young Adults in the Netherlands: A Retrospective Inception Cohort Study.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-04-09 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S496841

Guiling Zhou, Irene Mommers, Catharina C M Schuilinga-Veninga, Jens H J Bos, Katrien Oude Rengerink, Anna Maria Gerdina Pasmooij, Peter G M Mol, Debbie van Baarle, Geertruida H de Bock, Job F M van Boven, Eelko Hak

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引用次数: 0

Abstract

Background: 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).

Methods: 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.

Results: 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)).

Conclusion: 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.

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荷兰年轻人在COVID-19之前和期间吸入哮喘药物的分配模式：一项回顾性初始队列研究

背景：2019冠状病毒病（COVID-19）大流行对哮喘用药轨迹（包括用药类型或剂量的变化）的影响尚不清楚。本研究比较了大流行前（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分配模式。方法：采用格罗宁根大学IADB进行回顾性初始队列研究。社区药房调剂数据库。在2014年、2017年或2020年开始吸入性哮喘治疗的16-44岁个体随访2年。治疗步骤（1-5）基于全球哮喘倡议（GINA）指南。主要结局包括到治疗步骤切换的时间（增加或减少）和首次口服强的松/泼尼松的时间，并使用Cox回归模型在队列之间进行比较。结果：2014年、2017年和2020年，分别有1193例、960例和730例患者启动了哮喘吸入器。在所有队列中，超过一半的患者在最低步骤开始治疗。在2年的随访中，与2014年相比，2020年切换治疗步骤的患者较少(调整风险比（aHR）： 0.86（95%可信区间（CI）： 0.76-0.99）。从2014年到2020年，降压治疗的可能性随着时间的推移而下降，与2014年相比，2017年降压治疗的可能性为21% (aHR: 0.79(0.68-0.92))， 2020年降压治疗的可能性为24% (aHR: 0.76(0.64-0.90))，而降压治疗的可能性没有显著变化。2020年口服强的松/泼尼松的风险也显著降低（aHR: 0.76(0.61-0.94)）。结论：在大流行期间，较少的哮喘患者改变治疗步骤并服用口服强的松/泼尼松。自2014年以来，停药的人数减少了，2017年下降了21%，2020年下降了24%。可能的驱动因素包括依从性的提高、哮喘控制的改善以及远程医疗使用的增加——这些趋势早于大流行，并因大流行而加速。需要结合临床数据的研究来证实这些假设。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.