Traditionally, asthmatics experience a higher chance of contracting respiratory viral infections than the rest of the population [1]. During the COVID-19 pandemic, researchers have noted that, in many cases, asthmatics and other sufferers of long-term lung diseases have exhibited comparatively lower rates of infection [1]. In fact, asthma patients are not even among the top ten groups suffering from chronic health issues to have died from COVID-19 [2]. To understand this unexpected phenomenon, researchers investigated the biological mechanisms driving asthma and COVID-19 [2]. Their latest hypothesis could have major implications for the course of COVID-19 treatment: common asthma medications may be capable of lessening symptoms and reducing mortality rates [2].
A study by Oxford University found evidence for a positive effect of asthma medications [3]. The study examined AstraZeneca’s Pulmicort (also known as budesonide) [3]. Researchers divided 146 patients into two groups, one of which took 800mg of Pulmicort two times a day while the other received normal care [4]. Only one member of the Pulmicort group was hospitalized, compared to ten in the other cohort [4]. Additionally, the study found that patients on the Pulmicort regiment exhibited shorter hospitalizations and expedited symptom resolution [3]. When taken during their first week of symptoms, inhaled budesonide was even more effective [4]. While this news is promising, the small size of the study necessitates further research.
Researchers speculate that budesonide is effective at treating COVID-19 because the medication contains EDTA [2]. EDTA can disrupt COVID-19 infection by preventing SARS-CoV-2 surface spike proteins from fusing to the ACE-2 receptor [2]. EDTA is present in other common asthma medications as well, such as albuterol and metaproterenol, which could further explain the lower COVID-19 mortality rate in asthmatics [2].
Consequently, further research is needed. Another promising study, also conducted by Oxford researchers, tested how budesonide affects older adults suffering from COVID-19 [4]. Although it supported the aforementioned study’s findings, it has yet to be peer-reviewed [4]. Moreover, researchers are examining other corticosteroids beyond budesonide [4]. Five other corticosteroid studies are in the works now [4].
Conversely, some studies have indicated that asthma medications may not be so effective at treating COVID-19 patients. Near the end of 2020, a meta-analysis of five studies tested the benefits of corticosteroids on COVID-19 treatment [5]. Three of the studies reviewed demonstrated positive results, while two indicated no benefit from corticosteroid treatment [5]. Another sub-study suggested that corticosteroids may impede recovery from COVID-19; the reason for this negative impact is not clear [5]. Furthermore, steroids can contribute to long-term complications, such as cardiovascular and autoimmune issues, which have not been studied yet in the context of COVID-19 [6]. For now, researchers advise physicians to use corticosteroids only in critical cases [7].
Corticosteroids may bring us one step closer to the end of the pandemic. But before that can happen, they must be examined more to discover whether they are a reliable treatment for COVID-19 patients.
References
[1] A. Mandal, “Asthma inhalers being trialed for treatment of COVID-19,“ News Medical Life Sciences, Updated July 7, 2020. [Online]. Available: https://www.news-medical.net/news/20200707/Asthma-inhalers-being-trialed-for-treatment-of-COVID-19.aspx.
[2] D. P. Cashman, “Why the lower reported prevalence of asthma in patients diagnosed with COVID-19 validates repurposing EDTA solutions to prevent and manage treat COVID-19 disease,“ Medical Hypotheses, vol. 144, p. 1-5, November 2020. [Online]. Available: https://doi.org/10.1016/j.mehy.2020.110027.
[3] E. Pfanner, “AstraZeneca Asthma Drug Cuts Covid Hospitalizations in Study,“ Bloomberg, Updated February 10, 2021. [Online]. Available: https://bloom.bg/3uGsrGT.
[4] L. Geddes, “Asthma drug may reduce risk of severe Covid if taken early – study,“ The Guardian, Updated February 10, 2021. [Online]. Available: https://bit.ly/3uIr2zG.
[5] A. K. Singh et al., “Role of corticosteroid in the management of COVID-19: A systemic review and a Clinician’s perspective,” Diabetes & Metabolic Syndrome: Clinical Research & Reviews, vol. 14, no. 5, p. 971-978, September-October 2020. [Online]. Available: https://doi.org/10.1016/j.dsx.2020.06.054.
[6] P. Mattos-Silva et al., “Pros and cons of corticosteroid therapy for COVID-19 patients,” Respiratory Physiology & Neurobiology, vol. 280, p. 1-3, September 2020. [Online]. Available: https://doi.org/10.1016/j.resp.2020.103492.
[7] C. Tang et al., “Caution against corticosteroid-based COVID-19 treatment,” The Lancet, vol. 395, p. 1759-1760, June 2020. [Online]. Available: https://doi.org/10.1016/S0140-6736(20)30749-2.
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