Background: In recent decades, guidelines for treatment of chronic obstructive pulmonary disease (COPD) have shifted towards a more restrictive use of inhaled corticosteroid (ICS).

Aims and objectives: To identify the development over time in the use of ICS treatment in COPD on a national level in Denmark.

Methods: A register-based serial cross-sectional study using Danish nationwide registers. On a yearly basis, we included all patients ?40 years of age with an ICD-10 diagnosis J44 from 1995 to 2018. Accumulated ICS use was calculated during each year of the entire study period based on redeemed prescriptions. Patients were divided into the following groups: No ICS, low dose ICS, medium dose ICS, or high dose ICS.

Results: From 1995 to 2018, the yearly proportion of patients without ICS treatment increased (51.9% to 57.6%), the proportion of patients on low dose ICS treatment increased (12.3% to 14.9%), and the proportion of patients on high dose ICS treatment decreased (15.1% to 9.4%).

Conclusions: We have demonstrated a nationwide reduction in Denmark in the use of ICS treatment in COPD from 1995 to 2018. This is displayed by an increase in the proportion of patients without ICS and on low dose ICS treatment, and by a decrease in the proportion of patients on high dose ICS treatment.