Inhaled Glucocorticoids Could Ease COVID-19 Symptoms

Patients who received the inhaled glucocorticoid budesonide in the first several days of COVID-19 symptoms were much less likely to require hospital care.

A new study of patients with mild COVID-19 symptoms suggests treatment with the inhaled glucocorticoid budesonide (Pulmicort) can reduce the likelihood of hospitalization and shorten recovery periods.

The report, published in The Lancet Respiratory Medicine, could lead to improved, easily accessible care for patients at risk of severe COVID-19 disease.

Corresponding author Mona Bafadhel, MBChD, PhD, of the University of Oxford, and colleagues, began their study after noticing that patients with chronic respiratory disease seemed to be under-represented in the literature documenting hospitalization rates among patients with COVID-19.

“We hypothesized that this under-representation might be due to the widespread use of inhaled glucocorticoids in these patients,” Bafadhel and colleagues wrote.

In addition, the authors noted that most of the time, inhaled glucocorticoids are used by patients with asthma and chronic obstructive pulmonary disease (COPD) to reduce exacerbations, and those exacerbations are believed to be the result of viruses. Thus, they wondered, perhaps the drugs’ effectiveness in treating regular symptom exacerbations might translate to effectiveness against the SARS-CoV-2 virus.

The authors recruited 167 patients during the last half of 2020, each of whom had mild COVID-19 with symptoms beginning no more than 7 days prior to enrollment. Patients were randomly assigned to one of 2 groups: one received usual care, and the other received treatment with inhaled budesonide at a dose of 400 μg per actuation, administered via turbohaler. Patients were asked to take two inhalations twice per day until symptoms went away. The primary endpoint was COVID-19-related hospital admissions or emergency room visits. The secondary endpoint was patient-reported measures of symptoms. The analyses were run for both the per-protocol and intention-to-treat (ITT) populations.

A total of 139 patients were included in the per-protocol analysis. Among the 70 patients in the standard-care group, 10 (14%) received COVID-19 related urgent care. Of the 69 patients in the budesonide group, just 1 patient required emergency care.

Similarly, in the ITT population, 11 patients (15%) in the usual-care group sought emergency care, compared to 2 patients (3%) in the budesonide group. The number of patients needed to be treated with budesonide to reduce COVID-19 deterioration was 8.

Patients with budesonide had quicker resolution of symptoms compared to the usual-care group (8 days versus 7 days), and they also had fewer days with fever.

Bafadhel and colleagues said the therapy’s ability to lessen COVID-19 severity was significant.

“This effect, with a relative reduction of 91% of clinical deterioration is equivalent to the efficacy seen after the use of COVID-19 vaccines and greater than that reported in any treatments used in hospitalized patients with severe COVID-19,” they said.

Since their study had broad inclusion criteria, including patients with comorbidities and a median age in the mid-40s, the authors said their findings could be important for public health agencies around the world, especially in countries with fewer resources.

“In addition, in high-income countries, inhaled budesonide could work as an adjunct to reduce pressure on healthcare systems until widespread SARS-CoV-2 vaccination can be achieved,” they said.

The investigators said their findings will need to be validated, but they said such validation needs to take place quickly in order to maximize the impact of the potential new therapeutic option.