Two recent large studies in the UK have shown that inhaled budesonide, given early during COVID infection, reduced the time that people had symptoms and also prevented clinical worsening that required hospitalisation1.
Budesonide, a commonly used asthma drug, was used as a treatment shortly after people developed symptoms consistent with COVID-19, with a proportion of people confirmed on PCR testing to have acute infection.
However, a separate trial in Japan that used a different inhaled corticosteroid, ciclesonide, did not demonstrate a significant benefit.
National Asthma Council Australia Director and respiratory physician Professor Peter Wark said that in Australia it was still too early to recommend regular prescription of inhaled budesonide with COVID-19.
“At this stage The Australian guidelines for the clinical care of people with COVID-19 do not recommend the use of inhaled corticosteroids including budesonide outside of a clinical trial.
“However, the two clinical trials that showed the introduction of budesonide treatment early in the illness before people became unwell in primary care settings was extremely promising, well tolerated and not associated with any significant side effects of concern,” he said.
The mechanism of action of just how the inhaled budesonide works at the site where SARS-CoV-2 is likely to be causing its biggest effect is still unknown.
“It has been proposed that inhaled corticosteroids may reduce expression of the receptor that the virus uses in order to get into our cells and cause infection. This may then limit the spread of infection to the lungs,” Professor Wark added.
Professor Wark is now part of a team from the Centre for Healthy Lungs HMRI, University of Newcastle, and the University of Sydney Clinical trials centre and RPA virtual Sydney that have just received funding from NSW health for a trial of inhaled ciclesonide for people in NSW to prevent more severe COVID-19 disease and its effect on the spread of infection.
“Our aim will be to assess efficacy of inhaled ciclesonide in reducing the need for urgent medical care due to infection in those people who are in hotel or home quarantine with mild COVID-19 disease.
“We hope to see if this leads to a faster resolution of symptoms and whether people clear the virus more quickly with treatment,” he said.
1 Ramakrishnan, S., et al., Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. Lancet Respir Med, 2021.
Yu, L.-M., et al., Inhaled budesonide for COVID-19 in people at higher risk of adverse outcomes in the community: interim analyses from the PRINCIPLE trial. medRxiv, 2021: p. 2021.04.10.21254672.
Note to editor:
It is important to note that people in the trials did not have asthma. People with asthma should continue to use their inhaled medications, including inhaled corticosteroids including if they have or are suspected as having COVID-19. Stopping their inhaled corticosteroids will put them at increased risk of worsening asthma.
People should check with their doctor or a pharmacist before using budesonide if they are taking other long-term medicines, especially other corticosteroids.
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