Inhaled steroids may reduce risk of death from COVID-19 in asthma patients

Study shows severe asthma is associated with an increased risk of death from COVID-19, but inhaled steroids may reduce mortality.

A recent study has found that adult asthma patients are more likely to go to critical care than patients without a known lung condition, and those with severe asthma have a higher risk of death.

The analysis, led by Imperial and published in the Lancet Respiratory Medicine, looked at patients admitted to hospital with COVID-19, comparing those with a known lung condition and those without, to investigate the outcomes for the two groups.

“This study has implications for the millions of people in the UK with asthma” Dr Chloe Bloom Lead author

Asthma is a prevalent condition in the UK with 5.4 million people currently receiving treatment (Asthma UK). Typically, patients may use inhalers containing inhaled steroids to help manage their asthma.

Previous studies have not found a clear pattern that links the risk of death from COVID-19 to having an underlying lung condition and inhaled steroid use.

This study, a collaboration with the University of Edinburgh, University of Liverpool and University of Dundee, looked at over 75,000 people admitted to hospital with COVID-19 who were part of the Infection Consortium WHO Clinical Characterisation Protocol UK (ISARIC WHO CCP-UK) from across England, Wales and Scotland.

The researchers investigated what symptoms patients had and how unwell they were when they arrived at hospital, followed by what level of treatment they required and their risk of death.

They also investigated if using inhaled steroids affected a patient’s risk of death. Although intravenous steroids are known to reduce mortality in hospitalised patients, the effect of inhaled steroid is less clear 

Asthma more critical

Adult asthma patients (those over 16 years of age) were found to be more likely to go to critical care than patients without a known lung condition. However, patients with a non-asthma chronic lung condition (most likely chronic obstructive pulmonary disease, or COPD) were less likely to go to critical care.

The study also found that all patients with any lung condition, both asthma and other lung conditions, were more likely to receive non-invasive ventilation than patients without a known lung condition.

Patients under 50 years old with severe asthma, and all those over 50 years with another chronic lung condition, had an increased risk of death. However asthma patients aged over 50 years old who used inhaled steroids within two weeks of their hospital admission had a reduced risk of death, compared to patients without a known lung condition.

This shows a potential benefit of inhaled steroids in improving the health outcomes for asthma patients who contract COVID-19. The protective effect of inhaled steroids was not found in patients with a non-asthma chronic lung condition (like COPD).

Dr Chloe Bloom, lead author on the paper, commented “Our study found inhaled steroids were associated with a significant protective effect when used in asthma patients, aged 50 years or more, within two weeks of their hospital admission. This study has implication for the millions of people in the UK with asthma”.

Read the full paper: ‘Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK’ in the Lancet Respiratory Medicine.