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Treatment of COVID-19-exacerbated asthma: should systemic corticosteroids be used?
Kartik Kumar1, Timothy S C Hinks2, Aran Singanayagam1
1National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Insights
Systemic corticosteroids may benefit asthmatics with COVID-19. Unlike in other patients, these steroids can restore antiviral immunity impaired by asthma, potentially improving outcomes for coronavirus disease 2019 (COVID-19) exacerbations.
Area of Science:
- Immunology
- Respiratory Medicine
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, poses risks to asthmatics.
- Viruses frequently trigger asthma exacerbations, necessitating optimal management strategies during the pandemic.
- Current World Health Organization (WHO) guidance advises against corticosteroids in suspected COVID-19 due to concerns about impaired antiviral responses.
Purpose of the Study:
- To discuss the use of systemic corticosteroids in managing COVID-19-associated asthma exacerbations.
- To evaluate the appropriateness of WHO guidance in the context of asthma.
- To explore the potential benefits of corticosteroids in asthmatic patients with SARS-CoV-2 infection.
Main Methods:
- Literature review and discussion of current evidence regarding corticosteroid use in asthma and viral infections.
- Analysis of the immunological interplay between asthma, type 2 inflammation, and antiviral immunity.
- Examination of the potential impact of corticosteroids on innate antiviral responses in asthmatic individuals.
Main Results:
- Asthma exacerbations involve type 2 inflammation, which can suppress antiviral immunity.
- Corticosteroids suppress type 2 inflammation, potentially restoring antiviral defenses in asthmatics.
- This mechanism suggests corticosteroids may offer clinical benefits in COVID-19-associated asthma exacerbations, unlike in non-asthmatic patients.
Conclusions:
- Systemic corticosteroids may be beneficial for managing COVID-19-associated asthma exacerbations.
- The unique immunological profile of asthma may alter the risk-benefit balance of corticosteroid use in COVID-19.
- Further research is warranted to refine management guidelines for asthmatic patients during the SARS-CoV-2 pandemic.
Abstract:
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a new rapidly spreading infectious disease. Current guidance from the World Health Organization (WHO) highlights asthmatics as a high-risk group for severe illness from COVID-19. Viruses are common triggers of asthma exacerbations and the current SARS-CoV-2 pandemic raises several questions regarding the optimum management strategies. Here, we discuss the contentious issue of whether the mainstay therapy systemic corticosteroids should be used in the routine management of COVID-19-associated asthma exacerbations. Recent guidance from the WHO has advised against the use of corticosteroids if COVID-19 is suspected due to concerns that these agents may impair protective innate antiviral immune responses. This may not be appropriate in the unique case of asthma exacerbation, a syndrome associated with augmented type 2 inflammation, a disease feature that is known to directly inhibit antiviral immunity. Corticosteroids, through their suppressive effects on type 2 inflammation, are thus likely to restore impaired antiviral immunity in asthma and, in contrast to non-asthmatic subjects, have beneficial clinical effects in the context of SARS-CoV-2 infection.
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