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Review: Benefits of Inhaled Steroids Outweigh COVID-19 Risks

As pharmacists are aware, patients with asthma and chronic obstructive pulmonary disease have bene uncertain about the use of steroid inhalers since international health officials warned that the medications could increase COVID-19 risks. Now, a new review suggests that the benefits of those drugs outweigh the risks and that patients should keep using them as prescribed. Here are more details.

HUDDERSFIELD, UK – When the World Health Organization raised concerns about negative effects on the immune systems, patients with respiratory conditions using inhalers and nebulizers weren’t sure what to do.

WHO advised at the beginning of the COVID-19 pandemic that inhaled steroids could leave patients more susceptible to serious infections from the virus.

A review in the journal Respiratory Medicine advises, however, that the benefits of use of inhalers containing steroids outweigh the risks.

"It confused a lot of people," said lead author Syed Shahzad Hasan, PhD, of the Department of Pharmacy at the University of Huddersfield. "After the WHO advice, people thought that continuous use of steroids would leave them at a greater risk of contracting the virus or developing more than a mild version of CoViD-19."

Researchers write that WHO's warning was extremely worrisome for patients with asthma or chronic obstructive pulmonary disease (COPD). They cite a report from the British Thoracic Society that demand for inhalers had jumped by 400%, leading to shortages in the UK, following WHO's announcement.

“The potential detrimental effects of steroids on the immune system to fight viral infections had always been a concern for patients on long term steroids in chronic conditions,” according to the article. “A recent warning from WHO on systemic corticosteroid use amid COVID-19 raised suspicion among public and healthcare professionals regarding the safety of steroid use during the SARS-CoV-2 pandemic.”

Yet, the authors point out that “any unsolicited changes in medications use may lead to potentially severe exacerbations and may risk patient lives.” Their article sought to provide a critical review of clinical evidence and offers a detailed discussion on the safety and efficacy of corticosteroids in asthma and COPD patients, both with and without COVID-19.

They conclude, “The management of an exacerbation of asthma and COPD in the context of COVID-19 pandemic should follow the usual approach, including the use of short courses of rescue OCS, while consideration for avoiding the use of nebulized drug administration should be made due to concerns about the transmission of COVID-19 in hospitalized patients unless nebulized in an airborne isolation room with necessary precautions.”

The study team concedes, however, that research on the association between the use of ICS/OCS and the acquisition or severity of COVID-19 is limited and call for future studies.

"We found there is strong evidence that the benefits of continuing with steroids outweighs the risk," added co-author Hamid A. Merchant, PhD. “There is a risk that the immune system goes down, and there is a chance of acquiring infections but the benefits of continuing with steroids throughout were higher than the risks. We concluded by saying that the patients should continue their regular medicines including steroids."