USE OF CORTICOSTEROIDS IN ASTHMATICS DURING COVID 19: A NARRATIVE REVIEW

Inhaled corticosteroids (IC) have been associated with an increased risk of pneumonia in patients with Asthma and chronic obstructive pulmonary disease (COPD). Asthmatics are at an increased risk of developing exacerbations after infection by respiratory viruses such as Influenza virus (IV), Parainfluenza virus, Human metapneumovirus, respiratory syncytial virus (RSV), Rhinovirus (RV), and Human and severe acute respiratory syndrome Coronaviruses. Asthma itself, mainly when it is poorly controlled, is an independent risk factor for pneumonia. A subset of Asthmatics can have significant defects in their innate, humoral, and cell-mediated immunity arms. Despite being one of the essential drugs in asthma control, several inhaled corticosteroids have been implicated in the observed significantly increased incidences of pneumonia in asthmatics. The observed association may be due to promoting viral replication, inflammation, and impairing antiviral responses. With the current COVID 19 pandemic affecting millions of people worldwide and with mortality of more than 44-fold that of seasonal flu, it was necessary to revisit this subject. Most asthmatics are poorly controlled and are on inhaled corticosteroids, putting them in a high-risk group. Preliminary case series have shown that asthmatics experience a more adverse clinical course of SARS-CoV-2 infection than non-asthmatics. Hence while we are waiting for more studies that further narrates the association between COVID 19 and Asthma, we advise clinicians on the importance of individualizing their management plan in asthmatics with the main aim of achieving adequate disease control and selective use of inhaled corticosteroids so as to avoid unwanted adverse events.