COVID-19 O-004 : Prior Use of Inhaled Corticosteroids and COVID-19 Risk and Mortality: A Nationwide Population-based Cohort Study

Background There are concerns that inhaled corticosteroids (ICS) could increase the risk of coronavirus disease 2019 (COVID-19) and experiencing poor outcomes. Methods This nationwide population-based study evaluated 234427 individuals with COVID-19-related claims before May 15, 2020 in the Korean Health Insurance Review and Assessment database. Adjusted odds ratios (ORs) were used to compare the clinical outcomes between ICS users and nonusers. To evaluate susceptibility to COVID-19 among patients with chronic obstructive pulmonary disease (COPD) or asthma, a nested case-control study was performed using the same database to examine the association between ICS use and COVID-19 diagnosis. Results In total, 7341 patients were confirmed to have COVID-19, including 114 ICS users and 7227 nonusers. Among 5910 patients who were hospitalized, death was observed for 9% of ICS users (9/101 patients) and 4% of nonusers (209/5809 patients) (p=0.01). However, this association was not significant when adjusted for age, sex, region, comorbidities, and hospital type (adjusted OR, 0.94; 95% confidence interval [CI], 0.43-2.07; p=0.88). Furthermore, ICS use was not associated with an increased risk of respiratory outcomes (respiratory support and extracorporeal membrane oxygenation). The case-control analysis of COPD compared 640 cases with COVID-19 to 2560 matched controls without COVID-19, and the analysis of asthma compared 90 cases with COVID-19 to 360 matched controls without COVID-19. Use of ICS was not significantly associated with COVID-19 among patients with COPD (adjusted OR, 1.02; 95% CI, 0.46-2.25; p=0.97) or asthma (adjusted OR, 0.38; 95% CI, 0.13-1.17; p=0.09). Conclusions Prior ICS use was not significantly associated with COVID-19 risk in patients with COPD or asthma, nor with mortality and respiratory outcomes among patients with COVID-19. During the COVID-19 pandemic, there is no evidence to support discontinuation of ICS among patients with COPD and asthma.