# Impact of the COVID-19 Lockdown on Inhaler Adherence in Patients with COPD: A South Korean Nationwide Cohort Study

## TL;DR

A South Korean study found that COPD patients had lower inhaler adherence during the 2020 COVID-19 lockdown compared to the previous year.

## Contribution

This study is the first to analyze nationwide inhaler adherence in COPD patients during the early stages of the pandemic in South Korea.

## Key findings

- Medication adherence to COPD inhalers dropped significantly during the 2020 lockdown compared to 2019.
- The proportion of patients adherent to inhalers (≥80%) decreased from 22.0% to 18.0% during the lockdown.
- Adherent patients were typically in their 60s, from rural areas, and without cardiovascular disease.

## Abstract

Background/Objectives: 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. Method: 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). Result: 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; p < 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. Conclusions: 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.