- Published
- 01 November 2020
- Journal article
Use of inhaled corticosteroids in asthma and coronavirus disease 2019: Keep calm and carry on
- Authors
- Source
- Annals of Allergy, Asthma & Immunology
Abstract
Inhaled corticosteroids (ICS) are used as anti-inflammatory controller therapy given either alone or in a combination with long-acting bronchodilators for persistent asthma. The novel coronavirus disease 2019 (COVID-19) pandemic has inevitably focused attention on whether ICS could predispose to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, especially in older, male, obese, smokers with comorbidities including chronic lung diseases who are susceptible to severe COVID-19 infection and worse outcomes. In the later stages of COVID-19 infection, there is an acute inflammatory cytokine cascade including interleukin 1-beta (IL-1β), IL-6, and tumor necrosis factor alpha. This in turn results in a hyperinflammatory and coagulopathy state with acute respiratory distress syndrome and an attendant high morality rate. A United Kingdom (UK) database of 17 million adult patients reported that the presence of asthma without recent oral corticosteroid use was associated with an 11% increased risk of hospital death with COVID-19, and a 25% increased risk in those with recent oral corticosteroid use. The UK RECOVERY trial in COVID-19 showed that treatment with dexamethasone 6 mg daily in 2014 patients compared to usual care in 4321 patients resulted in a 20% and 35% reduction in deaths among those who required oxygen alone or invasive ventilation respectively. Although ICS exhibit dose-related systemic absorption from the lungs, the degree of attendant systemic glucocorticoid activity in patients with asthma is relatively low compared with that of oral corticosteroids. Whether or not ICS might confer a different risk-benefit profile in COVID-19 is presently unknown. Here, we discuss the positive and negative effects of using ICS in relation to COVID-19.
Rights
© 2020 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Cite as
Lipworth, B., Chan, R. & Kuo, C. 2020, 'Use of inhaled corticosteroids in asthma and coronavirus disease 2019: Keep calm and carry on', Annals of Allergy, Asthma & Immunology, 125(5), pp. 503-504. https://doi.org/10.1016/j.anai.2020.06.026