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)

Ravina Barrett, Robert Barrett

Research output: Contribution to journalArticlepeer-review


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. PLAIN LANGUAGE SUMMARIES (PLS) Asthma and chronic obstructive pulmonary disease (COPD) are long-term lung conditions, affecting 6 million & 1.2 million people respectively and causing breathing difficulties. Sufferers are at a higher risk of chest infections including the coronavirus. Regular use of prescribed medication stabilizes these conditions and prevents them from getting worse. It is common to be prescribed a combination of five to eight oral and inhaled medications. We investigated the impact of the pandemic on the dispensing of these specific medicines across England during the first wave. The English Prescribing Dataset was checked from January 2019 to February 2020 (14 months before the pandemic) and March to October 2020 (8 months after its onset). We find that since March 2020, salbutamol, aminophylline, ipratropium, and theophylline have not returned to their pre-pandemic levels. However, for all agents, there is great variability. Further analysis suggests these trends are not reversing, suggesting that people have not been using their medication as anticipated for 8 months, which is concerning. As a consequence of this work, we recommend that doctors specifically call these patients and discuss their health as a matter of urgency, we encourage patients to continue to take their medication. We advise policy changes to waive the NHS prescription levy for asthma and COPD medication and we seek more granular data for further harm quantification. There are several strengths and weaknesses to our analysis, and we need to conduct more studies to ask patients about their experiences.

Original languageEnglish
Pages (from-to)1605-1612
Number of pages8
JournalExpert Review of Respiratory Medicine
Issue number12
Publication statusPublished - 23 Sept 2021

Bibliographical note

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (,
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way

Funding Information:
for this study was provided by the University of Brighton. The authors would like to thank NHS Business Services Authority staff who helped with several information requests.

Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • asthma
  • chronic obstructive pulmonary disease
  • prescriptions
  • Public Health, Environmental and Occupational Health
  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy


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