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What do we know so far about inhaled steroids as a treatment or cure for COVID-19?

This article was published on
May 5, 2021

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April 19, 2021: A recent preprint study in people over 50 with underlying health conditions and over 65 with no noted health conditions found that their recovery time from COVID-19 infections was reduced when they inhaled budesonide twice a day for two weeks while at home. In comparison to the group who did not inhale this corticosteroid, participants stayed well and felt better when they used budesonide and were admitted to the hospital less than the group who did not take the drug. The recovery time for people in this trial was three days faster for those who took the drug and 32% of those who took it recovered within two weeks. Another recent study in The Lancet also found that people who used budesonide were less likely to require urgent medical care and had reduced time to recovery after early COVID-19.

In early September of 2020, the World Health Organization (WHO) issued guidance that a class of steroids called corticosteroids - specifically dexamethasone, hydrocortisone, and methylprednisolone - should be considered treatments for severe cases of COVID-19, but should not be used in milder cases. These steroids are given systemically, meaning through the veins or in an oral pill form. Inhaled steroids have not be recommended or approved for use in COVID-19 cases by the WHO or U.S. FDA. Inhaled corticosteroids (ICSs) are used to treat asthma and other lung diseases, such as chronic obstructive lung disease (COPD). Due to lack of sufficient scientific evidence, whether ICSs protect or contribute to worse outcomes in COVID-19 patients is still debated. According to NIH Clinical Trials website, a randomized clinical study by Oxford University is underway to understand if ICSs can prevent or treat COVID-19. The Lancet Respiratory Medicine Journal published more information in September 2020 on the relation of COVID-19 mortality and inhaled corticosteroids. The publication states that using ICS might reduce immunity to fight viruses and increase pneumonia in patients with COPD. ICS use has also shown protection against COVID-19 by reducing the frequency of exacerbations and replication of SARS-CoV-2. However, there were significant differences in age and underlying illnesses about the groups studied. Common devices used as inhalers include a metered-dose inhaler (MDI), nebulizer and dry-powder or rotary inhaler. There have been rumors circulating about using "nebulizers" to inhale steroids, such as the anti-inflammatory drug budesonide (brand name Pulmicort), to potentially treat COVID-19. "Nebulizers" are a type of inhaler that change liquid medications, like budesonide, into a mist that can be more easily inhaled into the lungs. Nebulizers can be more expensive than the most common type of inhaler used by people with asthma, and patients usually use nebulizers for specific reasons, such as if a child or someone with severe asthma is having difficulties inhaling medicine. Inhaled steroids like budesonide can have side effects, and are also crucial for patients with health conditions who do not have COVID-19, so these should only be used when recommended by your doctor. Budesonide can be inhaled or taken orally, and when inhaled is part of a family of anti-inflammatory medications called inhaled steroids that are primarily used to help manage symptoms for conditions like asthma and chronic obstructive pulmonary disease (COPD). Budesonide is a prescription-only drug that is not approved by the U.S. Food and Drug Administration (FDA) for treatment of COVID-19.

In early September of 2020, the World Health Organization (WHO) issued guidance that a class of steroids called corticosteroids - specifically dexamethasone, hydrocortisone, and methylprednisolone - should be considered treatments for severe cases of COVID-19, but should not be used in milder cases. These steroids are given systemically, meaning through the veins or in an oral pill form. Inhaled steroids have not be recommended or approved for use in COVID-19 cases by the WHO or U.S. FDA. Inhaled corticosteroids (ICSs) are used to treat asthma and other lung diseases, such as chronic obstructive lung disease (COPD). Due to lack of sufficient scientific evidence, whether ICSs protect or contribute to worse outcomes in COVID-19 patients is still debated. According to NIH Clinical Trials website, a randomized clinical study by Oxford University is underway to understand if ICSs can prevent or treat COVID-19. The Lancet Respiratory Medicine Journal published more information in September 2020 on the relation of COVID-19 mortality and inhaled corticosteroids. The publication states that using ICS might reduce immunity to fight viruses and increase pneumonia in patients with COPD. ICS use has also shown protection against COVID-19 by reducing the frequency of exacerbations and replication of SARS-CoV-2. However, there were significant differences in age and underlying illnesses about the groups studied. Common devices used as inhalers include a metered-dose inhaler (MDI), nebulizer and dry-powder or rotary inhaler. There have been rumors circulating about using "nebulizers" to inhale steroids, such as the anti-inflammatory drug budesonide (brand name Pulmicort), to potentially treat COVID-19. "Nebulizers" are a type of inhaler that change liquid medications, like budesonide, into a mist that can be more easily inhaled into the lungs. Nebulizers can be more expensive than the most common type of inhaler used by people with asthma, and patients usually use nebulizers for specific reasons, such as if a child or someone with severe asthma is having difficulties inhaling medicine. Inhaled steroids like budesonide can have side effects, and are also crucial for patients with health conditions who do not have COVID-19, so these should only be used when recommended by your doctor. Budesonide can be inhaled or taken orally, and when inhaled is part of a family of anti-inflammatory medications called inhaled steroids that are primarily used to help manage symptoms for conditions like asthma and chronic obstructive pulmonary disease (COPD). Budesonide is a prescription-only drug that is not approved by the U.S. Food and Drug Administration (FDA) for treatment of COVID-19.

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What our experts say

In early September of 2020, the World Health Organization (WHO) issued guidance that a class of steroids called corticosteroids - specifically dexamethasone, hydrocortisone, and methylprednisolone - should be considered treatments for severe cases of COVID-19, but should not be used in milder cases. These steroids are given systemically, meaning through the veins or in an oral pill form. Inhaled steroids have not be recommended or approved for use in COVID-19 cases by the WHO or U.S. FDA.

Inhaled corticosteroids (ICSs) are used to treat asthma and other lung diseases, such as chronic obstructive lung disease (COPD). Due to lack of sufficient scientific evidence, whether ICSs protect or contribute to worse outcomes in COVID-19 patients is still debated. According to NIH Clinical Trials website, a randomized clinical study by Oxford University is underway to understand if ICSs can prevent or treat COVID-19.

The Lancet Respiratory Medicine Journal published more information in September 2020 on the relation of COVID-19 mortality and inhaled corticosteroids. The publication states that using ICS might reduce immunity to fight viruses and increase pneumonia in patients with COPD. ICS use has also shown protection against COVID-19 by reducing the frequency of exacerbations and replication of SARS-CoV-2. However, there were significant differences in age and underlying illnesses about the groups studied.

Common devices used as inhalers include a metered-dose inhaler (MDI), nebulizer and dry-powder or rotary inhaler. There have been rumors circulating about using "nebulizers" to inhale steroids, such as the anti-inflammatory drug budesonide (brand name Pulmicort), to potentially treat COVID-19. "Nebulizers" are a type of inhaler that change liquid medications, like budesonide, into a mist that can be more easily inhaled into the lungs. Nebulizers can be more expensive than the most common type of inhaler used by people with asthma, and patients usually use nebulizers for specific reasons, such as if a child or someone with severe asthma is having difficulties inhaling medicine.

Inhaled steroids like budesonide can have side effects, and are also crucial for patients with health conditions who do not have COVID-19, so these should only be used when recommended by your doctor. Budesonide can be inhaled or taken orally, and when inhaled is part of a family of anti-inflammatory medications called inhaled steroids that are primarily used to help manage symptoms for conditions like asthma and chronic obstructive pulmonary disease (COPD). Budesonide is a prescription-only drug that is not approved by the U.S. Food and Drug Administration (FDA) for treatment of COVID-19.

Context and background

Recent studies have shown that the steroid dexamethasone may be effective in treating severe cases of COVID-19 when given orally or through an IV (intravenous). However, this same impact has not been demonstrated in patients with mild or moderate cases or when dexamethasone is administered through a nebulizer. It should be noted that giving steroids to patients who are not severely ill with COVID-19 might cause more harm than benefit as steroids are known to suppress the immune system rather than help it fight infections more strongly. Doctors have warned against off-label use and hoarding of drugs.

Resources

  1. Inhaled corticosteroids: A rapid review of the evidence for treatment or prevention of COVID-19 (Oxford Centre for Evidence-Based Medicine)
  2. STerOids in COVID-19 Study (STOIC)(NIH)
  3. Inhaled corticosteroids and COVID-19-related mortality: confounding or clarifying? (The Lancet)
  4. Inhaled corticosteroids may not increase COVID-19 mortality (News Medical)
  5. Weathering the Cytokine Storm in Susceptible Patients with Severe SARS-CoV-2 Infection (Journal of Allergy and Clinical Immunology)
  6. The inhaled corticosteroid ciclesonide blocks coronavirus RNA replication by targeting viral NSP15 (bioRxiv)
  7. Budesonide (Inhalation Route) (Mayo Clinic)
  8. Inhalers and Nebulizers (John Hopkins University)
  9. Asthma Medicine Not Proven as COVID-19 ‘Cure’ (FactCheck.Org)
  10. Corticosteroids for COVID-19 (WHO)
  11. Steroids Can Be Lifesaving for Covid-19 Patients, Scientists Report (NYT)
  12. Inhaled budesonide for COVID-19 in people at higher risk of adverse outcomes in the community: interim analyses from the PRINCIPLE trial (medRxiv)
  13. Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial (The Lancet)
  14. Asthma drug helps older people cope with Covid at home – study (The Guardian)

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