Has the COVID-19 pandemic affected medication adherence to inhaled nebulised therapy for patients at a large adult cystic fibrosis centre?

Objectives: The COVID-19 pandemic has led to immense challenges for healthcare systems worldwide. People with cystic fibrosis (CF) were included in the clinically extremely vulnerable group for complications of coronavirus by the UK government and advised to shield during a national lockdown. Data suggests that pandemic-related restrictions have been linked to a reduction in pulmonary exacerbation events (PEx). We sought to explore whether an increase in medicine possession ratio and potentially adherence may be a factor in this finding. Methods: 50 patients who received medication through a homecare delivery system at a single large adult centre were randomly selected. Data from 12 months ‘pre-lockdown’ was compared to data for 9 months following start of shielding in March 2020. MPR was calculated and capped at 100%. Medications that were started or stopped during the pandemic were not included. Wilcoxon signed rank test was used to compare pre- and post-values. Results: 91 prescription medications were valid for analysis (45 nebulised antibiotics, 34 mucolytics and 12 CFTR modulators). MPR increased for 41 prescriptions (45.1%), decreased for 21 medications (23.1%) and remained unchanged for 29 medications (31.9%). Median MPR increased from 83% [57–100%] to 89% [66–100%], p = 0.037. MPR for nebulised antibiotics significantly increased (median 75% [54–100%] vs 89% [61–100%], p = 0.027). Median MPR for CFTR modulators was 100% throughout and did not change for mucolytics (75% [42–100%] vs 78% [53–100%], p = 0.419). Conclusion: We report a significant change in medication possession in adults with CF during the coronavirus pandemic in the UK. It is unclear whether this change translated to an increase in adherence but may be one factor in the reported decrease in PEx events described during this time. It is notable that increases were largely driven by inhaled antibiotics and this may represent a concerted effort to achieve maximal protection from infection.