Are Inhaled Steroids Effective for Treating Patients with COVID-19?

Observational studies suggest that patients with asthma or chronic obstructive pulmonary disease (COPD) are underrepresented among COVID-19 hospitalizations. These observations raise the question of whether inhaled corticosteroids (ICS) might mitigate COVID-19 symptoms, since many patients with asthma or COPD routinely use ICS. In one small trial, patients with mild COVID-19 infections who did not use ICS before SARS-CoV-2 exposure had fewer hospitalizations when they received inhaled budesonide (Lancet Respir Med 2021; 9:763). Researchers now report results from a much larger, randomized, non–placebo-controlled intervention.

This trial involved 1856 older high-risk patients (age, ≥65 [or ≥50 with comorbidities such as cancer, diabetes, cardiovascular or lung disease, or obesity]) with symptomatic COVID-19 for as long as 14 days (average, 6 days) who did not require hospitalization. Patients received usual care plus budesonide (800 µg, inhaled twice daily for 14 days) or usual care alone. Median time to self-reported recovery was 2.9 days shorter in the budesonide group, with a nonsignificant trend toward fewer hospitalizations and deaths.