Inhaled Corticosteroid Use for COPD, Asthma Does Not Affect COVID-19 Outcomes

Asthma inhaler
Asthma inhaler
In patients with COPD and asthma who are hospitalized for COVID-19, how does pre-hospitalization ICS use affect the clinical course of COVID-19?

Inpatients with COVID-19 with comorbid chronic obstructive pulmonary disease (COPD) or asthma were not protected from intubation or death by pre-hospitalization use of inhaled corticosteroids (ICS). Moreover, inpatients with COVID-19 and comorbid COPD have a higher mortality rate than those with comorbid asthma. These were among study results presented at the 2022 CHEST Annual Meeting, held October 16 to 19, 2022, in Nashville, Tennessee.

Reviewers sought to evaluate the impact of pre-hospitalization ICS use on the outcomes of inpatients with COVID-19 and comorbid COPD or asthma. The primary endpoints were 28-day mortality and the need for intubation.

The investigators initiated a retrospective chart review of 356 patients with prior diagnosis of obstructive lung disease who had been hospitalized with COVID-19 at an unnamed institution from March 2020 until the beginning of June 2020. ICD-10 codes were used to identify diagnoses of COPD and asthma. Of these patients, 38% had COPD and 62% had asthma. The researchers found that patients with asthma vs COPD were more likely to be female (69% vs 48%), younger (mean age 61 [range 51-71] vs 74 [67-81]), never/nonsmoking (52% vs 20%), and Hispanic (43% vs 25%) (all P <.01).

The investigators found no statistical difference in the use of pre-hospitalization ICS between the groups (COPD 38.0% vs asthma 35.2%; P =.59). Moreover, pre-hospitalization ICS use was not significantly associated with the need for intubation (COPD odds ratio [OR] 0.7 [95% CI, 0.3-1.7]; P =.41; asthma OR 1.0 [95% CI, 0.5-2.0] P =.94) or with all-cause 28-day mortality (COPD OR 0.7 [95% CI, 0.3-1.5]; P =.3; asthma OR 0.9 [95% CI, 0.4-2.0]; P =.85) after adjusting for potential confounders. Notably, patients hospitalized for COVID-19 who had COPD were more likely to die than those with asthma (47% vs 25%, respectively; P <.01).

Review limitations include the retrospective design and lack of data on pre-hospitalization ICS dosage and duration.

The study authors noted that “While the pre-hospitalization use of ICS was similar between the 2 groups, it did not protect hospitalized COVID-19 patients in either group from intubation or mortality.” The researchers concluded that comorbidities and concomitant risk factors were responsible for the higher mortality rate among patients with COVID-19 and comorbid COPD. “Further studies are required to investigate the role of ICS in preventing COVID-19 related hospitalizations, morbidity and mortality in randomized control settings,” said study authors.


Marliere MH, Hernandez Romero G, Reyes FM, et al. Impact of inhaled corticosteroid use on outcomes in hospitalized patients with COVID-19 and obstructive lung diseases. Presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.