COVID-19 and Asthma: The truth about steroids

There has been a great deal of talk about steroids, asthma and COVID-19 infection.  Because COVID-19 is a respiratory infection, patients with asthma may be fearful that they will face more significant symptoms if they become infected.   Furthermore, the CDC (Centers for Disease Control) has stated that patients with moderate-severe asthma may be at higher risk for serious infection complications, but there is little evidence to support that asthma is a significant risk factor in the data which is currently available.  Rather, age and immune compromise seem to be the largest risk factors and other medical conditions including diabetes, heart disease, and other lung disease seem to compound these.

This post will try to clarify what we know and what we don’t know, and most importantly, what you should do if you have asthma.

TRUE or FALSE:  Steroids make infection with COVID-19 worse.

TRUE (maybe) – There is some early evidence related to serious COVID-19 infection (SARS-Cov-2) and older evidence related to SARS-Cov-1 (from 2002-4), that systemic steroids do not help and may, in some instances, make things worse. Systemic steroids are usually give by IV in a hospital or ICU setting.  Systemic steroids can also be high dose oral steroids like prednisone and methylprednisolone. The most important complication of COVID-19 infection is pneumonia leading to ARDS (acute respiratory distress syndrome).  ARDS is an endpoint to many respiratory infections, including bacterial pneumonia and influenza-associated pneumonia.  ARDS in general does not respond to treatment with systemic steroids.   For patients in the hospital for COVID-19, systemic steroids are NOT part of the currently recommended treatment.

TRUE or FALSE:  Stopping my inhaled steroids will help me fight COVID-19.

FALSE: There is no evidence that inhaled steroids, which are routinely used to treat asthma and COPD (chronic obstructive pulmonary disease), have a negative impact on COVID-19 infection.  In fact, having asthma and COPD under maximal control is likely to benefit a person if they were to be infected by COVID-19.  The purpose of inhaled steroids is to minimize inflammation in the lungs and help the lungs work as if they did not have asthma.  In the face of a serious respiratory infection, lungs which can work optimally makes a lot of sense. Additionally, it does not appear that COVID-19 infection typically causes asthma attacks or exacerbation.   So, if you have asthma DO NOT STOP YOUR INHALED STEROIDS.

TRUE or FALSE:  If I have an asthma attack, I should not take oral steroids right now. 

FALSE: During this time, both patients and doctors are rightfully concerned about possible infection with COVID-19.  That being said, there are many other causes of asthma exacerbation including other viruses, allergens, and air quality.  When treating worsening asthma symptoms, especially when there is no fever or other symptoms consistent with serious COVID-19 infection, oral steroids may be the best treatment option for a patient.  You and your doctor, who knows your personal history and your asthma, will need to review your current symptoms and discuss treatment options that are best for you.

– Dr. Lora Stewart

For more information, see the website.

Comments ( 0 )