Twenty years of inhaler therapy: a nationwide drug-utilization study

Twenty years of inhaler therapy: a nationwide drug-utilization study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 20 January 2026 V1 Latest version Share on Twenty years of inhaler therapy: a nationwide drug-utilization study Authors : Katrine Bitsch Johansen [email protected] , Lars Lund , Zandra Ennis , Andrew Scourfield , Anders Løkke , and Sidsel Arnspang Pedersen Authors Info & Affiliations https://doi.org/10.22541/au.176891776.61023586/v1 121 views 102 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Aim This study aimed to map nationwide trends and prescribing patterns in inhaler use from 2004 to 2023. In light of evolving clinical guidelines and attention to the environmental impact of inhalers within recent years, we also examined variation in prescribing behaviour and patient-level treatment choices. Methods Using nationwide health registries, we identified all individuals redeeming prescriptions for pressurised metered-dose inhalers (pMDIs), dry powder inhalers (DPIs) and soft mist inhalers (SMIs) in Denmark over the past 20 years. Analyses included trends in total use, new and chronic use, patient demographics, comorbidities, markers of disease severity, and prescribing sector. Subgroup analyses stratified use patterns by inferred diagnosis (asthma vs. COPD) and repeated main analyses excluding children <6 years. Results From 2004 to 2023, total inhaler doses increased by 15%, driven primarily by a 62% rise in pMDI use. The pMDI share of total doses grew from 29% to 42%. New pMDI users increased by 34%, while long-term pMDI users nearly doubled (93%). DPI use declined slightly. pMDI and SMI users had higher rates of exacerbations and prednisolone use compared to DPI users. More than 90% of inhalers were prescribed in primary care. Conclusion pMDI use in Denmark has increased substantially over the past two decades, particularly among long-term users. These findings highlight a complex interplay of clinical, behavioural, and systemic factors influencing inhaler choice. As clinical guidelines evolve and awareness of inhalers’ environmental impact grows, targeted strategies is needed to optimise prescribing practices for both improved patient outcomes and climate sustainability. Supplementary Material File (bjcp_main manuscript_twenty years of inhaler therapy - a nationwide drug-utilization study.docx) Download 687.78 KB Information & Authors Information Version history V1 Version 1 20 January 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Authors Affiliations Katrine Bitsch Johansen [email protected] Syddansk Universitet Klinisk Institut View all articles by this author Lars Lund Syddansk Universitet View all articles by this author Zandra Ennis Odense Universitetshospital View all articles by this author Andrew Scourfield University College London Hospitals NHS Foundation Trust View all articles by this author Anders Løkke Syddansk Universitet Institut for Regional Sundhedsforskning View all articles by this author Sidsel Arnspang Pedersen Syddansk Universitet Klinisk Institut View all articles by this author Metrics & Citations Metrics Article Usage 121 views 102 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Katrine Bitsch Johansen, Lars Lund, Zandra Ennis, et al. Twenty years of inhaler therapy: a nationwide drug-utilization study. Authorea . 20 January 2026. DOI: https://doi.org/10.22541/au.176891776.61023586/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. 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