The potential protective role of corticosteroid therapy in patients with asthma and COPD against COVID-19

Abstract

Background The observation of patients hospitalized for coronavirus disease (COVID-19) led us to note a lower prevalence of patients affected by chronic respiratory disease, in particular asthmatic patients, compared to the general population. Therefore, the aim of this paper is to evaluate the possible protective role of corticosteroid therapy in patients with chronic lung disease, regarding the risk of contracting severe COVID-19. Main body SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) receptors to enter the cells. Considering the high number of these receptors in patients affected by asthma and chronic obstructive pulmonary disease (COPD), the evidence that these patients do not have a high risk of hospitalization for COVID-19 needs further study to understand what the possible protective “factors” are in these patients. In particular, the finding in some studies of reduced coronavirus replication in cell lines treated with steroids, molecules commonly used for treating chronic lung diseases, needs further attention. Short conclusion The hypothesis that corticosteroids, commonly used in treating airways diseases, might modify the severity of SARS-CoV-2 disease has become a key point and a possible predictive factor of a positive outcome of COVID-19 in patients treated everyday with these molecules.

Relationship between asthma and severe COVID-19: a national cohort study

“… 4 In addition, some studies have suggested that the use of inhaled corticosteroids (ICS) in asthma may have a protective effect and may be contributing to a decreased risk of severe COVID-19 disease. 5 6 …”

“…However, a recently published systematic review concluded that people with asthma are not at increased risk for acquiring COVID-19 compared with those without and also have similar outcomes following a COVID-19 infection compared with people without asthma 4. In addition, some studies have suggested that the use of inhaled corticosteroids (ICS) in asthma may have a protective effect and may be contributing to a decreased risk of severe COVID-19 disease 5 6…”

The association between pre‐existing asthma and reduced risk of death among children and adolescents hospitalized with COVID‐19 in Brazil

“…Some studies have suggested that inhaled asthma medications' antiviral and immunomodulatory activities should also be considered 35 . In this regard, some authors have argued that inhaled corticosteroids may have a protective effect, contributing to a decreased risk of severe COVID‐19 in patients with asthma 36 . Some behavioral aspects may also have played a role in reducing the vulnerability of asthma patients to SARS‐CoV‐2 infection 37 .…”

“…35 In this regard, some authors have argued that inhaled corticosteroids may have a protective effect, contributing to a decreased risk of severe COVID-19 in patients with asthma. 36 Some behavioral aspects may also have played a role in reducing the vulnerability of asthma patients to SARS-CoV-2 infection. 37 However, it is essential to emphasize that asthma is a complex disease, and more clinical and experimental studies are needed to elucidate the mechanisms involved in the interactions between asthma and SARS-CoV-2 infection.…”

Regular Inhaled Corticosteroids Use May Protect Against Severe COVID-19 Outcome in COPD

“…To date, published (mostly laboratory) studies and reviews rather suggest a potential preventive effect of pre-morbid and continued use of ICS against a hyperinflammatory response. [8][9][10] A recent study, in contrast, reported that pre-morbid ICS use in COPD was not protective and even increased risk of developing COVID-19. 11 A systematic review of more recent studies about pre-morbid and continued use of ICS found no evidence that ICS use was associated with worse outcomes, even though results and conclusions are likely confounded by different factors (ICS indication, sample size, lack of adjustment for comorbidities).…”