- COPD and asthma patients should not discontinue their corticosteroid medication during the pandemic
- An analysis found that there is not enough evidence to prove that inhaled or oral corticosteroids can increase the severity of Covid-19
- The health risks would be worse for these patients if they discontinued their chronic medication
The World Health Organisation has been cautioning medical professionals on the use of corticosteroid while treating Covid-19, but many patients suffering from chronic obstructive pulmonary disease (COPD) and asthma depend on these steroids to manage their conditions.
Changes in these types of chronic medications could have detrimental effects on health, which in turn would make it harder for such patients to fight the coronavirus.
The discussion about corticosteroids
UK researchers analysed the current clinical evidence on steroid intake during the pandemic to see if it is indeed safe for COPD and asthma sufferers to continue using their inhalers and other medications during the pandemic. They published their review in Respiratory Medicine.
The WHO made its decision in March based on the evidence that showed that corticosteroids – inhaled or taken orally – had an adverse effect on viral pneumonia patients in previous coronavirus outbreaks, and could also be the case with Covid-19.
Scientists say that inhaled corticosteroids (ICS) may impair the body's immune response by affecting a certain type of white blood cell – neutrophils – which may compromise COPD patients' ability to completely flush the virus from their system.
This recommendation has made asthmatic and COPD patients on inhalers extra fearful of catching the disease.
Meta-analysis paints a different picture
"However, the meta-analysis showing an increased risk for respiratory infection associated with ICS use, is comparatively small in asthmatic patients and includes pooled estimates with wide confidence intervals in COPD patients, and therefore the association is relatively weak."
The type of medication used can also have an effect. Studies have shown that fluticasone poses higher risk because it stays in the airways longer than budesonide, which clears faster and does not increase the risk of respiratory infections and pneumonia.
Some preprint studies have also indicated that some types of ICS blocked the coronavirus strain from replicating in its host.
"Therefore, we have no reason to believe that there is a direct pathological relationship between ICS use and Covid-19."
While studies involving oral corticosteroids have found an increased risk when using these medications for respiratory infections, the analysts question whether the data is reliable, as COPD and asthma increase patients' risk of contracting Covid-19 even without corticosteroids.
Low numbers of cases
While COPD and asthma patients were expected to have an increased risk when it comes to Covid-19, there has been an underrepresentation of these patients among coronavirus cases. This contributes to the theory that ICS and OCS inhibit the replication of the virus.
"Besides, the use of ICS may limit or improve symptoms of the disease where ICS users may not be symptomatic to seek testing or treatment," the analysts added.
For COPD and asthma patients who haven't been infected by Covid-19 yet, the researchers maintain it's important that they stick with their current medicinal regime to ensure that their conditions aren't exacerbated, which may require emergency assistance, which in turn might increase their risk of coronavirus infection.
"The benefit of continuing ICS therapy based on the respective guidelines outweighs the suspected risk of respiratory infection."
Be careful with OCS and nebulisers
While ICS is still recommended for asthmatics, its impact on COPD patients is still uncertain and should therefore be avoided, while the small percentage of patients with allergic asthma on OCS therapy should be put on the lowest dose possible to manage symptoms properly.
They also note that sudden withdrawal from OCS medication can also put COPD patients' health at risk, and this far outweighs the benefits of discontinuing ICS and OCS therapies just because of potential Covid-19 risks.
This notion is backed up by various COPD and asthma organisations, like the Global Initiative for Asthma, European Lung Foundation and the American Lung Association.
"However, patients should be reminded that a short course of OCS should not be self-initiated in the presence of Covid-19 symptoms, such as fever, dry cough, or myalgia."
Care, however, should be taken when it comes to nebuliser solutions of corticosteroids as they can spread the virus in hospital settings through airborne transmissions. The analysts advise that metered-dose inhalers with spacer devices be used instead of nebulisers, or that nebuliser solutions be used in a secure isolation room.
Studies are still lacking, however, about the direct link between ICS and OCS, and whether they cause increased susceptibility to Covid-19 or an increased severity of the disease.