Background: The Coronavirus disease 2019 (COVID-19) pandemic caused a staggering 200 million cases with over 4 million deaths globally as of August 2021. COVID-19 is associated with lung inflammation and pulmonary fibrosis. Inhaled corticosteroids (ICS) are used to improve lung function by reducing inflammation, edema, mucus secretion, and inhibiting various cytokine activities. However, there is limited data on the effect of ICS usage in patients with COVID-19.The aim of our study is to evaluate mortality of COVID-19 patients receiving ICS for obstructive lung diseases or ICS in combination with other treatments as part of COVID-19 treatment compared to standard treatment.

Methods: We followed PRISMA guidelines and MOOSE protocol for conducting the systematic review and meta-analysis comparing ICS and standard COVID-19 therapy. A search on PubMed between December 2019 to August 2021 was conducted yielding 270 articles of which 6 manuscripts were finalized for inclusion in the study. Patients with COVID-19 are identified from the studies based on confirmed positive RT-PCR tests. The data on ICS utilization and mortality were collected. Using RavMan 5.4, we performed random-effects models to estimate the pooled effect size (pooled odds ratio), 95% confidence interval (95% CI), and heterogeneity (I2). Forest plots were obtained and p < 0.05 was considered statistically significant.

Results: Of the six studies, five reported mortality. We noted a higher prevalence of mortality in patients with asthma (60.88%, 107/160) and chronic obstructive pulmonary disease (COPD) (68.46%, 382/558). We found that ICS use was associated with higher odds of mortality (OR=1.45 95%CI: 1.10-1.91; p=0.009, I2= 68%) amongst COVID-19 patients. In subgroup analysis, higher odds of mortality among COPD patients using ICS was noted [pooled OR: 1.52 (1.24-1.86); p< 0.0001; I2=0%]. However, no significant association between ICS and mortality was observed among asthma patients.

Conclusions: ICS use was associated with increased mortality compared to standard care in patients with COVID-19. Prospective studies are required to confirm the safety and efficacy of ICS usage in patients with COVID-19.

IMAGE 1: COVID-19 mortality among Inhaled Corticosteroids users