Patients with asthma and chronic obstructive pulmonary disease (COPD) appear to have increased their adherence to inhaler medications in the wake of the coronavirus disease 2019 (COVID-19) pandemic, according to emerging evidence published in the Journal of Allergy and Clinical Immunology: In Practice.

The authors of this clinical correspondence collected data from Propeller Health, a digital platform that tracks inhaler use through electronic medication monitors. A total of 7578 individuals (77% with asthma; 67% women) were included in the analysis.

From the first 7 days of January to the last 7 days of March 2020, there was a 14.5% increase in mean daily controller adherence (53.7% to 61.5%), according to the collected data. There were no clinically meaningful differences in adherence between patients with asthma and patients with COPD when adjusted for age. More than 50% of patients achieved ≥75% adherence to controller medication during the last week of March, representing a 14.9% increase from the first week of January.

The authors noted this is not the first time inhaler adherence has spiked during specific months. For example, in September and October, during rhinovirus season, adherence has peaked in children aged 4 to 17 years. Similarly, adults have increased their adherence in November through February.


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“Although we cannot definitely state the cause of improvement in adherence, the trend may reflective of patients responding to national COVID-19 guidelines and to patient concern about controlling their primary respiratory illness with their controller medications,” the study authors wrote.

They added that the evidence thus far in the COVID-19 pandemic is encouraging and hopefully will reduce the need for acute care in these patients.

We asked David Stempel, MD, senior vice president of clinical and medical affairs at Propeller Health and coauthor of this clinical correspondence, to share additional insights on inhaler adherence during the COVID-19 pandemic.

Is there any evidence to suggest that consistent, correct inhaler use could reduce the odds of patients with COPD or asthma having a severe course of COVID-19?

Based on the evidence available so far, asthma does not seem to be associated with a higher risk related to COVID-19, as seen in COPD.

The best reason for adherence is to keep people with asthma and COPD out of the emergency department and under control, so that they do not have an exacerbation that requires them to come into contact with people who may have been exposed to COVID-19.

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Is there any concern regarding potential medication shortages for these patients? And if so, are there any protocols put in place to handle such a shortage?

We are not aware of any shortages, and those questions would be best posed to [the drug] manufacturer[s]. That said, the Centers for Disease Control and Prevention recommends that people with asthma and COPD stock up on a 14 to 30 day supply of medication in case they need to be home for a long period of time.

Were there any potential differences between patients with asthma and COPD in terms of inhaler adherence?

In this analysis, people with COPD displayed higher adherence rates than people with asthma, but when corrected for age, the difference between the 2 is similar. For both diseases, people older than 60 are quite adherent to their medication regimen, and the patients with COPD cohort skews older because of the progressive nature of the disease.

Disclosure: This study was supported by Propeller Health. Please see the original reference for a full list of authors’ disclosures.

Reference

Kaye L, Theye B, Smeenk I, Gondalia R, Barrett MA, Stempel DA. Changes in medication adherence among patients with asthma and COPD during the COVID-19 pandemic [published online May 1, 2020]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2020.04.053