Researchers from Huddersfield University say the benefits of using steroid-containing inhalers and nebulisers during the COVID-19 pandemic outweigh the risks, despite warnings to the contrary.
The WHO advised back in March that steroids used in inhalers and nebulisers – often prescribed to people with asthma or COPD – could have a negative effect on immunity, potentially increasing susceptibility to COVID-19.
Dr Hamid Merchant and Dr Syed Shahzad Hasan from the University of Huddersfield commissioned research into the use of steroids and risk of infections, especially viral infections of the upper respiratory tract.
“It confused a lot of people,” says Dr Hasan. “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.”
The study, published in Respiratory Medicine, assessed evidence and findings from a range of bodies including the British Thoracic Society and the National Institute for Health and Care Excellence (NICE).
“We found there is strong evidence that the benefits of continuing with steroids outweighs the risk,” declares Dr Merchant. “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.”
The authors said: “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 nebulised drug administration should be made due to concerns about the transmission of COVID-19 in hospitalised patients unless nebulised in an airborne isolation room with necessary precautions”.
However, they also note that studies are lacking on the association between the use of inhaled or oral corticosteroids and the acquisition or severity of COVID-19, and so suggest that future studies should aim collect further data to ascertain their potential benefits or harms in COVID-19.