November 2023
Do inhaled steroids help in patients with COVID-19?

Fourteen days of inhaled fluticasone did not shorten duration of COVID­-19 symptoms.

Systemic corticosteroids are helpful for patients with severe COVID­-19 who require hospitalisation with supplemental oxygen. The role of inhaled corticosteroids is less clear, with previous trials yielding conflicting results.

Almost 1300 adults with mild­-to­-moderate COVID­-19 who had symptoms for fewer than seven days were randomised to 200­-mcg fluticasone furoate (Breo) or placebo for 14 days. About 13% of patients had asthma, and two-­thirds were vaccinated. Time to recovery (defined as three symptom­-free days) was not different between groups. A combined endpoint of urgent­-care or emergency department visits, hospitalisa­tions and death was reached slightly more frequently in the fluticasone group; however, serious complications were rare, with only three hospitalisations in each group and no deaths.

Comment: A previous trial of open­-label budesonide in older unvaccinated patients did show a small benefit (NEJM JW Gen Med Sep 15 2021 and Lancet 2021; 398: 843­-855), but the current study was a resounding failure for inhaled fluticasone. I will continue inhaled corticosteroids in COVID­-19 patients with asthma who are using inhaled corticosteroids already, but based on this study, I will no longer start inhaled corticosteroids in patients with COVID­-19.

David J. Amrol, MD, Associate Professor of Clinical Internal Medicine, Director of the Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, USA.

Boulware DR, et al. Inhaled fluticasone furoate for outpatient treatment of Covid­-19. N Engl J Med 2023; 389: 1085­-1095.

This summary is taken from the following Journal Watch titles: General Medicine, Infectious Diseases, Ambulatory Medicine.

N Engl J Med