Stay on Steroids in Face of COVID-19, Say Experts

Advice for those in the general population infected with COVID-19 is that “corticosteroids are to be avoided” during treatment, according to the CDC as well as the World Health Organization.

This current consensus that there is no reason “to expect that patients [in general] with COVID-19 infection will benefit from corticosteroids, and they might be more likely to be harmed with such treatment,” is also detailed in a Lancet commentary published last month.

This is because corticosteroids may “inhibit immune responses and pathogen clearance” of COVID-19, say the commentary authors, led by Clark D. Russell, MBChB, of the Centre for Inflammation Research, University of Edinburgh, UK.

And one of China’s coronavirus experts has identified prolonged, high-dose corticosteroid use as a major risk factor for COVID-19 death.

“We conclude that corticosteroid treatment should not be used for the treatment of COVID-19–induced lung injury or shock outside of a clinical trial,” say Russell and colleagues.

No Evidence That Staying on Steroids Worsens COVID-19 in Asthma

With regular influenza, not maintaining good symptom control is much more likely to result in patients with asthma being hospitalized, going to the ICU, and dying.

And there’s currently no evidence to suggest the advice should be any different for COVID-19, say experts.

“The most important thing for an individual with asthma to avoid the complications of any viral respiratory infection, including COVID-19, is to maintain good control of their asthma,” emphasized James Sublett, MD, past president of the ACAAI, and cofounder and chief medical officer of Family Allergy & Asthma, based in Louisville, Kentucky.

“We don’t have any data that patients who stay on their preventive medication have more severe problems, more hospitalizations [with COVID-19],” said Blaiss.

Eric Macy, MD, an allergist–immunologist at Kaiser Permanente in San Diego, California, and a fellow of the American Academy of Allergy, Asthma & Immunology, agrees: “There are no data at this time that I am aware of that support an alternative plan.”

Blaiss said that only the most severe asthma patients will be on oral corticosteroids anyway, “and with the advent of biologics, the vast majority switched.”