Introduction: In Jun 2020, the New Zealand (NZ) adolescent and adult asthma guidelines recommended budesonide-formoterol (bud-form), taken as maintenance and/or reliever therapy, as the preferred therapeutic approach. We wanted to investigate whether this recommendation was associated with changes in clinical practice.

Methods: NZ national dispensing data for inhaler medications from Jan 2010 to Dec 2021 were reviewed. Monthly ?dispensings? of inhaled bud-form, inhaled corticosteroid (ICS), other ICS-long-acting beta2-agonists (LABA), and inhaled short-acting beta2-agonists (SABA), for the 12+ age group, were displayed graphically with piecewise regression used to produce plots of rates by time with a 1 Jul 2020 break point. The number of dispensings in the last six months that data was available (Jul-Dec 2021) was compared with the corresponding period, Jul-Dec 2019.

Results: Bud-form dispensing increased markedly after 1 Jul 2020 (regression coefficient 41.1 inhalers dispensed/100,000 population/per month (95%CI: 36.3 to 45.6, P<0.0001); 64.7% increase in number of dispensings between Jul-Dec 2019 and Jul-Dec 2021), in contrast to other ICS-LABA (regression coefficient -15.9 (95%CI: -22.2 to -9.6, P<0.0001); -1.7% decrease) and SABA (regression coefficient -14.7 (95%CI: -29.7 to 0.3, P=0.055); -10.6% decrease), respectively.

Conclusion: A progressive increase in bud-form dispensing, accompanied by a reduction in SABA and ?other ICS-LABA? dispensing, occurred following publication of the 2020 NZ asthma guidelines. These findings suggest that the transition to a bud-form reliever-based stepwise management approach can be achieved at a national level if incorporated in evidence-based guidelines.