Initial observed improvement in medication adherence maintained during the COVID-19 pandemic in asthma and COPD

<bold>Rationale:</bold> Controller medication adherence among patients residing in the US with asthma and COPD increased at the start of the COVID-19 pandemic. <bold>Objective:</bold> We sought to determine if early trends in medication adherence persisted throughout 2020. <bold>Methods:</bold> We examined patterns of controller medication use for adults (>18 years of age) with self-reported asthma and/or COPD who enrolled in a digital self-management platform between January and December 2020. The digital platform included an electronic medication monitor (EMM) to track the date and time of medication use, and a paired smartphone app to provide insights on medication usage trends and reminders for missed doses. Mean daily adherence was defined as the percent of controller puffs taken/puffs prescribed, capped at 100%, and averaged for the last week of each respective study month. <bold>Results:</bold> Among 20,908 participants (84% asthma, 72% female), the median (IQR) age was 52 (39-63) years. In the last week of January 2020, before designation of a global pandemic, mean adherence was 55.3%. Adherence steadily increased throughout 2020, with a peak of 62% in November. The expected seasonal dip in summer months was not observed. Daily adherence was higher among patients with COPD (vs. asthma), and among those who were older (≥ 50 vs. < 50 years). The proportion of patients with ≥ 75% daily adherence increased from approximately 47% to 56% from January to December. <bold>Conclusions:</bold> Patients enrolled in a digital self-management platform to manage their asthma and COPD maintained increased controller medication adherence throughout 2020. Efforts to evaluate the underlying behavioral drivers behind this trend are needed.