Intranasal corticosteroids mitigate loss of smell in chronic rhinosinusitis with COVID-19
Doctors should consider intranasal corticosteroids for patients with chronic rhinosinusitis who also have COVID-19 to minimize loss of olfactory function, according to a study published in Allergy and Asthma Proceedings.
This use of intranasal corticosteroids (INCs) does not aggravate the clinical course of COVID-19, Can Tuzer, MD, of the department of internal medicine’s division of immunology and allergic diseases at the Istanbul Faculty of Medicine, Istanbul University, and colleagues wrote.
The researchers recruited 71 patients (median age, 39 years; interquartile range, 26-47; 62% women) with chronic rhinosinusitis (CR) from four adult allergy outpatient clinics in Istanbul who also had developed COVID-19. These patients were evaluated using the 22-item Sino-Nasal Outcome Test, VAS and total symptom score-6 (TSS-6) before and after developing COVID-19.
Also, patients were categorized into two groups. The 21 patients in group 1 used regular INCs but nothing else when they had COVID-19. The second group included 24 patients who used antihistamines and/or leukotriene receptor antagonists (LTRA), or group 2a, and 26 patients who did not use these drugs, or group 2b.
The study population included 48 (67.6%) with allergic rhinitis (AR), including 12 (25%) in group 1, 17 (35.4%) in group 2a and 19 (39.6%) in group 2b, and 23 (32.4%) with non-AR.
The most common symptoms in all patients before developing COVID-19 were runny nose (n = 57; 80.3%), nasal blockage (n = 57; 80.3%), nose blowing (n = 53; 74.6%), sneezing (n = 52; 73.2%) and postnasal discharge (n = 36; 50.7%).
During COVID-19 illness, the most common symptoms were fatigue (n = 36; 50.7%), decreased sense of smell and/or taste (n = 36; 50.7%), cough (n = 28; 39.4%), nasal blockage (n = 25; 35.2%) and dizziness (n = 21; 29.6%).
There were remarkable increases in SNOT-22 total scores during COVID-19 compared with before patients developed the disease (P < .001) in all groups, the researchers said, while only the patients in groups 2a and 2b saw significant increases in total physical symptoms related to CR during COVID-19.
All the groups saw increases in quality-of-life impairments during COVID-19 as well (P < .001). Group 1 saw no significant increase in reduced smell and/or taste scores during COVID-19, but groups 2a and 2b saw significant increases (P < .001). In fact, the researchers said, group 1 had a significantly smaller reduction in smell and/or taste during COVID-19 compared with groups 2a and 2b.
There were no significant differences in VAS between the three groups’ VAS scores before and during COVID-19, although participants with AR had significant differences in their TSS-6 scores between the study periods.
Also, groups 1 and 2 had similar frequencies of symptoms related to COVID-19 except for reduced smell and/or taste (P = .02). Nine members of group 1 (42.9%) and 36 members of group 2 (72%) had reductions in smell and/or taste (OR = 0.292; 95% CI, 0.101-0.844).
Patients with CR who also have COVID-19 can use INCs to effectively prevent impaired taste and/or smell, the researchers concluded, without any harmful impact on COVID-19 clinical outcomes or severity.
Perspective
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This is not surprising. INCs allow for calm nasal mucosa and can decrease the synergistic inflammatory drive that occurs in the face of a concomitant upper respiratory infection that can worsen nasal symptoms and impair sense of smell temporarily.
It is helpful to know that patients who remain on INCs do not experience a higher rate of serious illness or impairment, so standard treatment for AR and CR are safe during the pandemic.
In general, these results line up with my own clinical and research experience. They have been seen observationally in other upper respiratory infection situations as well.
Patients who are on INCs or use them intermittently for AR or CRS can increase their use within prescriptive limits to improve nasal symptoms and decrease inflammatory cytokines in the nasal mucosa.
One limitation from this research, however, is that it would be hard to know if the patients who were on INCs would have had a different course if they had been off INCs. Given the variability in presenting symptoms in COVID-19, it is hard to predict how patients would respond and what symptoms would be present with or without INCs. Other research could look at the use of sprays vs. rinses with steroid, once a day vs. twice day usage, and so on.
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