Use of corticosteroids in asthma and COPD patients with or without COVID-19

Abstract

The potential detrimental effects of steroids on the immune system to fight viral infections had always been a concern for patients on long term steroids in chronic conditions. A recent warning from WHO on systemic corticosteroid use amid COVID-19 raised suspicion among public and healthcare professionals regarding the safety of steroid use during the SARS-CoV-2 pandemic. The corticosteroids (inhaled and oral) are commonly prescribed in the management of asthma and COPD patients and any unsolicited changes in medications use may lead to potentially severe exacerbations and may risk patient lives. This article provides a critical review of clinical evidence and offers a detailed discussion on the safety and efficacy of corticosteroids in asthma and COPD patients, both with and without COVID-19.

High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry

“…Although recent studies have shown that the use of GC s in the moderate to severe acute phase of COVID-19 has led to a benefit, 20 21 the effect seems to be deleterious in patients on chronic use, probably associated increased risk of infection with higher dose of GC, 22 due to impairment of innate immune responses with a reduction in neutrophil recruitment and a delay in viral clearance. 23 …”

The dynamic association between COVID-19 and chronic disorders: An updated insight into prevalence, mechanisms and therapeutic modalities

“…In general, both the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend that patients should be maintained on their regular therapy and that no medication should be discontinued ( (GINA) GIfA, 2020 ; (GOLD) GIfCOLD, 2020 ). In patients infected with COVID-19 who have asthma or COPD exacerbations, the usual course of management, including the administration of a short course of oral corticosteroids should be followed but only under the supervision of a physician ( Hasan et al, 2020 ). Lastly, an important point to consider in clinics is the risk of viral transmission via nebulized treatment.…”

“…Lastly, an important point to consider in clinics is the risk of viral transmission via nebulized treatment. It has been recommended that patients with COVID-19 associated asthma or COPD exacerbation should not be administered bronchodilators or corticosteroids through nebulization, to avoid the risk of infecting other patients and healthcare providers ( Hasan et al, 2020 ). In these cases, metered-dose inhalers are preferred, however if not possible then patients using the nebuliser in their homes or in a clinical setting should take their medication in an isolated room and take the necessary precautions ( Hasan et al, 2020 ).…”

Asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome and the risk of severe COVID-19

“…Compared to inhaled corticosteroids coupled with long-acting β2-agonists, dual long-acting bronchodilators may exhibit a more significant reduction of exacerbation frequency, while bearing a lower risk of pneumonia. However, sometimes it may be necessary to continue ICS-including therapy in case of good symptoms control [45].…”

“…Delaying the therapy is not recommended, as severe exacerbations may occur in this time. Short-term use of oral corticosteroids is favourable in the resolution of more severe disease symptoms and can be abandoned suddenly, as the exacerbations vanish [45].…”