Inhaled corticosteroids fail to protect against COVID-19-related death in asthma, COPD

A new study found no benefit of inhaled corticosteroid use in protecting against COVID-19-related mortality in patients with asthma and COPD.

Researchers conducted an observational study to analyze patient-level data for 148,557 patients with COPD and 818,490 patients with asthma culled from primary care electronic health records with death data from the OpenSAFELY platform from March to May.

Patients with COPD were aged at least 35 years, current or former smokers and were prescribed an inhaled corticosteroid (ICS) or long-acting beta agonist plus long-acting muscarinic antagonist within the previous 4 months. Patients with asthma were aged at least 18 years, diagnosed with asthma within the previous 3 years and were prescribed an ICS or short-acting beta agonist within the previous 4 months.

Researchers compared COVID-19-related mortality between those prescribed an ICS and those prescribed alternative respiratory medications.

Risk for COVID-19-related mortality was increased among patients with COPD prescribed an ICS compared with those prescribed LABA and LAMA combination therapy (adjusted HR = 1.39; 95% CI, 1.1-1.76). Those with asthma who were prescribed high-dose ICS had an increased risk for COVID-19-related mortality compared with patients prescribed SABAs (aHR = 1.55; 95% CI, 1.1-2.18), but those prescribed low- or medium-dose ICS were not at an increased risk (aHR = 1.14; 95% CI, 0.85-1.54), according to the results.

The researchers said the observed association among ICS prescription and COVID-19-related mortality may be explained through underlying health differences between those prescribed ICS and those prescribed alternative respiratory medications for asthma and COPD.

“We found no evidence of a beneficial effect of regular ICS use among people with COPD and asthma on COVID-19-related mortality. Although we report a small harmful association, the pattern of results we observed suggests this association could readily be explained by differences in underlying health between people prescribed ICS and those prescribed other respiratory medications,” Anna Schultze, PhD, research fellow in pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, and colleagues wrote in The Lancet Respiratory Medicine. “These results do not support any change to the current clinical guidelines for the routine treatment of people with COPD or asthma with ICS during outbreaks of SARS-CoV-2 infection.”