The polyhedric reality of the interaction between COVID-19, asthma and inhaled corticosteroids

Abstract

In December 2019, a pneumonia outbreak of unknown origin was identified in Wuhan, China. It was given the label coronavirus disease 2019 (COVID-19) and the virus causing it was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. On 11 March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic [3]. By 5 April 2022, there had been 490 853 129 confirmed cases of COVID-19, including 6 155 344 deaths, reported to the WHO [4]. As of 4 April 2022, a total of 11 183 087 530 vaccine doses had been administered but, despite this, there is still a relevant case incidence rate throughout the world [4]. In the last few months of the pandemic, factors associated with a higher incidence rate or worse prognosis of COVID-19 have been identified, such as older age, obesity, high blood pressure and diabetes mellitus [5–8].

Comorbid asthma decreased the risk for COVID-19 mortality in the United Kingdom: Evidence based on a meta-analysis

“…In contrast, other studies have provided evidence that ICS may be associated with an additional risk of adverse COVID-19 outcomes and a prolonged time to viral clearance [63] , [64] , [65] . However, ICS in previous studies have not shown a clear or consistent association with COVID-19 outcomes [66] , [67] , [68] . Given the immunomodulatory effects of ICS and the controversial results, Terry et al recently found that ICS use in asthmatics was associated with decreased mortality in COVID-19 [69] .…”

The association of preexisting severe asthma with COVID-19 outcomes

“…prognosis, including inhibition of pro-inflammatory cytokine and chemokine production and antiviral effects [13,14,48,53,54].…”

“…Furthermore, mAb and/or high-dose ICS may confer additional risk of poor COVID outcomes in these patients [ 12 , 20 ]. For example, ICS use may increase risk of pneumonia in patients with asthma [ 48 ], reduce ACE-2 expression [ 49 ], or reduce the number of eosinophils in blood [ 50 ], all possible indicators of poor COVID-19 prognosis [ 51 , 52 ]. However, mechanisms have also been suggested by which ICS use may improve COVID-19 prognosis, including inhibition of pro-inflammatory cytokine and chemokine production and antiviral effects [ 13 , 14 , 48 , 53 , 54 ].…”

Coronavirus disease 2019 and severe asthma

“…The use of ICS in asthmatics with COVID-19 diseases has generated conflicting positions among clinicians who supported the possibility of an increased susceptibility towards the development of severe COVID-19 disease and those who argued in favor of their protective role in avoiding SARS-CoV-2 infection or protecting against the risk of severe COVID-19 disease [29 ▪▪ ]. In September 2020, an observational study conducted by Schultze et al [30] highlighted an increased risk of death in asthmatic patients using high dose of ICS, showing a lack of protective role against COVID-19 death in the analyzed studied population.…”