Common asthma treatment reduces hospitalisation by 90%

[Doireallyneedaname]

www.thelancet.com/action/showPdf?pii=S2213-2600%2821%2900160-0

“ We have shown that the inhaled glucocorticoid budesonide, given for a short duration, might be an effective treatment of early COVID-19 in adults. This effect, with a relative reduction of 91% of clinical deterioration is equivalent to the efficacy seen after the use of COVID-19 vaccines14 and greater than that reported in any treatments used in hospitalised patients and patients with severe COVID-19.”

Interesting comment about Multiple early reports of patients admitted to hospital with COVID-19 showed that patients with chronic respiratory disease were significantly under-represented in these cohorts.

Would explain why asthmatics have not been as vulnerable as first anticipated.

That is interesting

it's commom, but most asthmatics will be on a diffeent steroid. I wonder if other inhaled steroids would have the same results?

Yes the steroids (and some other immunosuppressants) seem to help treat covid.

Which suggests that possibly asthmatics NOT on regular medication are higher risk than those who are? If so, this group of 'mild' asthmatics should've been prioritised for the vaccine.

There have been a couple of studies like this, but my understanding is that a lot of asthmatics in the UK are, like me, on beclametasone, either alone or in combination - I'm on Fostair. I've not come across any studies on beclametasone.

A lot of asthmatics are on that particular steroid. I am, and at the dose used in the study. I have severe asthma and was put on the shielding list because of it.

dexamethasone is also a corticosteroid, but a cheaper one than budesonide.

The Lancet study was funded by the Budesonide manufacturer. And it's super small RCT, just 167 participants. I can believe it has benefits but it may not be generally superior to the other corticosteroid treatments known to work well to reduce covid bad outcomes.

My bet is that other inhaled corticosteroid asthma drugs have similar benefits in presence of covid infections, by having similar biological action.

Early on we didn't know it was inflammatory systemic responses that led to a lot of the worst covid outcomes.

That is really interesting. I'm convinced I had covid early last year (covid toe, headaches, exhaustion etc) but my chest was fine. I did wonder whether it might be the steroid inhaler.

@Tealightsandd

Which suggests that possibly asthmatics NOT on regular medication are higher risk than those who are? If so, this group of 'mild' asthmatics should've been prioritised for the vaccine.

I don’t think so because apparently chronic respiratory patients were actually under represented in general, thus evidencing lower risk to all asthmatics (and possible other respiratory conditions).

That's interesting Haenow I suppose because it's more an inflammatory disease than respiratory?

I'm on Fostair too, plus another drug, and was in government shielding. I did get covid for several weeks, and I'm sure my medication really helped me.

The regular medication issue may mask the fact that some asthmatics take inhalers when they are ill only.

I'm intrigued about beclometasone too as I have been on Fostair for a few years and before that Qvar. I know quite a few people who take those, but as far as I know, nobody on budesonide

@MedSchoolRat

dexamethasone is also a corticosteroid, but a cheaper one than budesonide.

The Lancet study was funded by the Budesonide manufacturer. And it's super small RCT, just 167 participants. I can believe it has benefits but it may not be generally superior to the other corticosteroid treatments known to work well to reduce covid bad outcomes.

My bet is that other inhaled corticosteroid asthma drugs have similar benefits in presence of covid infections, by having similar biological action.

Early on we didn't know it was inflammatory systemic responses that led to a lot of the worst covid outcomes.

Very interesting isn’t it. I was frustrated when many asthmatics were removed from the priority groups, but, otoh, I’ve been following the situation with regard to inhaled steroids and did wonder (and hope) that my high dose inhaled budesonide might actually and up being beneficial rather then my asthma being a risk iyswim. I’ve been keeping myself as ‘safe’ as possible and definitely keeping on top of my asthma probably more than ever jic.

That's interesting. I have mild exercise wheeze (ventolin only) and I was floored by covid last year. My chest was badly affected.

@kimlo

it's commom, but most asthmatics will be on a diffeent steroid. I wonder if other inhaled steroids would have the same results?

Yes, a lot are on e.g. Seretide, a different steroid. Is it specifically budesonide that is effective?

Me too. I've got mild asthma, wheezy mainly on exercise and changes in temperature. I use qvar and a ventolin inhaler. Covid floored me as well. Took 6 weeks to feel even normal and 11 weeks before I could resume work. Currently having a relapse...
From experience at work most of our critically ill patients had high bp/diabetes/copd/asthma.

I'm on Clenil Modulite (Beclometasone dipropionate) - a light brown inhaler, as well as my ventolin. Does anyone know if this is a steroid? I took it when I had Covid and it seemed to help - both the blue and brown inhalers helped.

Yes it is a steroid

@Runningshorts

That's interesting. I have mild exercise wheeze (ventolin only) and I was floored by covid last year. My chest was badly affected.

Snap. I hadn’t used my blue inhaler for months and they ended up prescribing me a new one - my chest is way worse than it was pre Covid.

It's horseshit.

If you read the paper you'll see the tiny number of participants.
Then look at the following - two groups, each with/without the budesonide.
#Urgent care visit required
Group With Budesonide Without
Group 1 (per-protocol) 10 1
Group 2 (ITT) 2 11

The conclusions focus entirely on the "benefit" shown in the second group, but the numbers from the first group show the statistical failure here.

The drug MAY be of benefit, but this study isn't worth the paper it's not printed on.

Arf - my carefully aligned table has been destroyed!

Hopefully you get the two columns, "with" and "without" and the numbers underneath.

It’s only a small phase 2 trial though - a larger scale phase 3 including older / diverse participants would be interesting, as would longitudinal data.

interesting thank you