tetano
Editor, Senior Moderator
Ann Allergy Asthma Immunol
. 2023 Jul 4;S1081-1206(23)00487-8.
doi: 10.1016/j.anai.2023.06.026. Online ahead of print. Intranasal steroid use and COVID-19 mortality among asthma and COPD patients: A retrospective cohort study
Dr Virginia Hernandez Santiago[SUP] 1 [/SUP], Dr Adeniyi Francis Fagbamigbe[SUP] 2 [/SUP], Prof Frank Sullivan[SUP] 2 [/SUP], Dr Utkarsh Agrawal[SUP] 2 [/SUP], Dr Daniel Morales[SUP] 3 [/SUP], Prof Colin McCowan[SUP] 2 [/SUP], Prof Brian Lipworth[SUP] 3 [/SUP]
Affiliations
Background: Systemic corticosteroids have been widely used for treating patients with severe acute respiratory distress syndrome. Inhaled corticosteroids may have a protective effect for treating acute COVID-19, however little is known about the potential effect of intranasal corticosteroids (INCS) on COVID-19 outcomes and severity.
Objective: To assess the impact of prior chronic INCS exposure on COVID-19 mortality in patients with chronic respiratory disease, and the general population.
Methods: Retrospective cohort study. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between INCS exposure and all-cause and COVID-19 mortality, adjusted by age, sex, deprivation, exacerbations in the last year, and comorbidities.
Results: Exposure to INCS did not have a significant association with COVID-19 mortality among the general population, COPD or asthma cohorts, with HRs of 0.8 (95%CI 0.6 to 1.0, p=0.06), 0.6 (95%CI 0.3 to 1.1, p=0.1) and 0.9 (95%CI 0.2 to 3.9, p=0.9), respectively. INCS exposure was however significantly associated with reduction in all-cause mortality in all groups, which was 40% lower (HR=0.6 (95%CI 0.5 to 0.6, p<0.001)) among the general population, 30% lower (HR 0.7, 95%CI 0.6 to 0.8, p<0.001) in COPD patients, and 50% lower (HR 0.5, 95%CI 0.3 to 0.7, p=0.003) amongst asthmatics.
Conclusion: The role of INCS in COVID-19 is still unclear, but exposure to INCS does not adversely affect COVID-19 mortality. Further studies are needed to explore the association between their use and inflammatory activation, viral load, ACE2 gene expression, and outcomes, exploring different types and doses of INCS.
Keywords: Asthma; COPD; COVID-19; SARS-CoV-2; coronavirus; intranasal corticosteroids.
. 2023 Jul 4;S1081-1206(23)00487-8.
doi: 10.1016/j.anai.2023.06.026. Online ahead of print. Intranasal steroid use and COVID-19 mortality among asthma and COPD patients: A retrospective cohort study
Dr Virginia Hernandez Santiago[SUP] 1 [/SUP], Dr Adeniyi Francis Fagbamigbe[SUP] 2 [/SUP], Prof Frank Sullivan[SUP] 2 [/SUP], Dr Utkarsh Agrawal[SUP] 2 [/SUP], Dr Daniel Morales[SUP] 3 [/SUP], Prof Colin McCowan[SUP] 2 [/SUP], Prof Brian Lipworth[SUP] 3 [/SUP]
Affiliations
- PMID: 37414336
- DOI: 10.1016/j.anai.2023.06.026
Background: Systemic corticosteroids have been widely used for treating patients with severe acute respiratory distress syndrome. Inhaled corticosteroids may have a protective effect for treating acute COVID-19, however little is known about the potential effect of intranasal corticosteroids (INCS) on COVID-19 outcomes and severity.
Objective: To assess the impact of prior chronic INCS exposure on COVID-19 mortality in patients with chronic respiratory disease, and the general population.
Methods: Retrospective cohort study. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between INCS exposure and all-cause and COVID-19 mortality, adjusted by age, sex, deprivation, exacerbations in the last year, and comorbidities.
Results: Exposure to INCS did not have a significant association with COVID-19 mortality among the general population, COPD or asthma cohorts, with HRs of 0.8 (95%CI 0.6 to 1.0, p=0.06), 0.6 (95%CI 0.3 to 1.1, p=0.1) and 0.9 (95%CI 0.2 to 3.9, p=0.9), respectively. INCS exposure was however significantly associated with reduction in all-cause mortality in all groups, which was 40% lower (HR=0.6 (95%CI 0.5 to 0.6, p<0.001)) among the general population, 30% lower (HR 0.7, 95%CI 0.6 to 0.8, p<0.001) in COPD patients, and 50% lower (HR 0.5, 95%CI 0.3 to 0.7, p=0.003) amongst asthmatics.
Conclusion: The role of INCS in COVID-19 is still unclear, but exposure to INCS does not adversely affect COVID-19 mortality. Further studies are needed to explore the association between their use and inflammatory activation, viral load, ACE2 gene expression, and outcomes, exploring different types and doses of INCS.
Keywords: Asthma; COPD; COVID-19; SARS-CoV-2; coronavirus; intranasal corticosteroids.