Should we give COVID-positive patients without asthma ICS as a preventer of respiratory distress syndrome?

What the research says:

There is limited data on the effectiveness of early administration of inhaled corticosteroids (ICS) for the treatment of COVID-19 illness in patients without asthma or any other condition that clearly needs it. One single Phase 2 trial (STOIC trial) with 167 patients found that early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery after early COVID-19 (Ramakrishnan et al 2021). However, meta-analysis of observational data has failed to show a statistically significant benefit for ICS in non-asthmatic patients when compared with standard care in terms of mortality prevention (Kow and Hasan 2021). Moreover, ICS therapy in non-asthmatic patients may lead to unnecessary side effects, overcoming any potential benefit.

There are currently no clinical guidelines recommending the use of ICS for non-asthmatic patients with early, non-severe COVID-19 illness. However, there is emerging evidence that patients at high risk of being admitted to hospital with COVID-19 may benefit from ICS therapy. More results are required before a recommendation can be made. Supporting this evidence are interim results from the PRINCIPLE trial that found that inhaled budesonide reduced the time to recovery by a median of 3 days among people with COVID-19 and reduced risk factors for adverse outcomes including older age (≥65 years) or ≥50 years with comorbidities. (PRINCIPLE Collaborative Group 2021). A number of other clinical trials for budesonide and ciclesonide (Deokar et al 2021) are currently ongoing and recommendations will be updated depending on the outcomes of these studies.