Inhaled Corticosteroids Do Not Adversely Impact Outcomes in COVID-19 Positive Patients with COPD: An Analysis of Cleveland Clinic's COVID-19 Registry

Background: Inhaled Corticosteroids (ICS) are commonly prescribed to patients with severe COPD and recurrent exacerbations. Given the concern for increased viral shedding by corticosteroids, as observed with previous coronavirus strains, it is not known what impact ICS cause in terms of COVID-19 positivity or disease severity in COPD patients.  Methods: This study examined 27,810 patients with COPD from the Cleveland Clinic COVID-19 registry between March and September 2020. Electronic health records (EHR) were used to determine diagnosis of COPD, ICS use, and clinical outcomes. Multivariate logistic regression was used to adjust for demographics and comorbidities known to be associated with increased risk for severe Coronavirus disease-19 disease.  Findings: Amongst the COPD patients who were tested for COVID-19, 44.1% of those taking an ICS-containing inhaler tested positive for COVID-19 versus 47.2% who tested negative (p=0.033). Of those who tested positive, (n=1288), 371 (28.8%) required hospitalization. In-hospital outcomes were not significantly different when comparing ICS versus no ICS in terms of developing sepsis (28.4% vs 26.5%, p=0.77), ICU admission (36.8% vs 31.2%, p=0.30), endotracheal intubation (21.9% vs 16.5%, p=0.24), or mortality (18.4% vs 20.0%, p=0.80).  Multivariate logistic regression demonstrated no significant differences in hospitalization (adj OR 1.12, CI: 0.90-1.38), ICU admission (adj OR: 1.31, CI: 0.82-2.10), need for mechanical ventilation (adj OR 1.65, CI: 0.69-4.02), or mortality (OR: 0.80, CI: 0.43-1.49).  Interpretations: ICS therapy did not increase COVID-19 related healthcare utilization or mortality outcome in patients with COPD. These findings should encourage clinicians to continue ICS maintenance therapy for COPD patients during the COVID-19 pandemic.  Funding: No sources of funding were used. Declaration of Interests: The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Ethics Approval Statement: This study and the registry were both approved by the Cleveland Clinic Institutional Review Board (IRB#20-391).