Outpatient utilization trend of bronchodilator and anti-inflammatory agents in the pandemic and beyond

As COVID-19 primarily affects the respiratory system, it may have impacted utilization patterns of drugs used in obstructive airway diseases (DOADs). We examined nationwide DOAD utilization trends before, during, and after pandemic measures. We collected data on DOADs (ATC-Code: R03) between 01.01.2017-28.02.2023 from IQVIA-Turkey. National outpatient sales and prescription projections were converted into consumption data, expressed as defined daily dose per 1,000 inhabitants (DID). We compared mean monthly consumption, costs, and quarterly DOADs use across "before restrictions" (BfR), "during restrictions" (DuR), and "after restrictions" (AfR) periods. We identified 433.5 million DOAD units consumed, costing €3.3 billion; inhaled-DOADs accounted for 73.1%. Mean monthly DOAD consumption remained stable (BfR: 67.8 ± 3.1 DID; DuR: 74.2 ± 12.5 DID; AfR: 74.2 ± 14.6 DID; p > 0.05). Inhaled-DOADs exhibited a similar pattern, except the anticholinergics with a significant increase in the DuR (19.4 ± 3.3 DID) compared to the BfR (16.1 ± 2.3 DID, p < 0.001). Also inhaled-corticosteroid monotherapy rose significantly between BfR (4.1 ± 0.9 DID) and AfR (5.3 ± 1.3 DID, p < 0.05). Montelukast, constituting 76.6% of systemic-DOADs, had higher consumption in AfR (15.0 ± 2.8 DID) than in BfR (11.7 ± 2.2 DID, p < 0.001) and DuR (12.9 ± 2.4 DID, p < 0.05). Overall DOAD prescriptions declined in DuR and trended upward in AfR but didn't reach pre-pandemic levels, except for new users of montelukast and long-acting beta agonists. Our study showed increased use of inhaled anticholinergics, glucocorticoid monotherapy, and montelukast within a generally stable overall DOAD utilization. This may reflect varied responses to bronchodilation and anti-inflammatory treatment needs during the pandemic and beyond.