Trends in inhaler prescription – a comparison of prescription data from three European countries

Introduction Inhaler therapy prescription for chronic airway diseases is based on clinical considerations to choose the optimal treatment and takes into account the environmental impact of the prescription. Pressurized metered dose inhalers (pMDI) contain greenhouse gas propellants, contributing significantly to carbon emissions. Guidelines increasingly recommend DPIs to reduce environmental burden. This study compared Dry Powder Inhaler (DPI) usage to other inhalation administration forms in Germany, Belgium and Slovenia between 2014 and 2023. Methods Prescription data were analyzed by Anatomical Therapeutic Chemical (ATC) Classification System codes. Specific prescribing rates were assessed for Short-Acting Beta2-Agonist (SABA), Long-Acting Beta2-Agonist (LABA), Inhaled Corticosteroids (ICS), anticholinergics, and combination therapies: Adrenergics in combination with corticosteroids or other drugs, excl. anticholinergics (Combi_1) and Adrenergics in combination with anticholinergics incl. triple combinations with corticosteroids (Combi_2). Results In all countries SABA remained dominated by non-DPI forms, while LABA favored DPIs despite overall usage decline. Overall anticholinergic prescriptions decreased significantly, particularly DPIs (decrease of DPI proportions -28,5% in Germany, -43,3% in Belgium, -54,2% in Slovenia). The proportion of DPI in ICS declined in all countries (-6,9% in Germany, -9,9% in Belgium, -13,7% in Slovenia). Combi_1 showed declining DPI percentages (-6% in Germany, -4.1% in Belgium, -10,5% in Slovenia). Combi_2 increased substantially, with stronger DPI growth in Germany (+20,8%) than Belgium (+14,5%) and Slovenia (+12,5%). Conclusion The evolution of prescription trends was comparable in the three countries. Traditional SABA prescription remained unchanged. The divergence in DPI proportions between the different drug types could be influenced by multiple factors requiring further investigation. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany