Compliance With Inhaled Corticosteroid Therapy in Asthma Patients Who Have COVID-19 Leads to Better Outcomes

OBJECTIVES: The extensive use of inhaled corticosteroids among asthma patients has frequently been reported as a preventive measure against developing severe forms of COVID-19. The main goal of the study was to verify or disprove the hypothesis that Adherence to an Inhaled Medication Application Technique (A-AppIT) is negatively correlated with COVID-19 severity, likely due to the incomplete or absent protective effect of inhaled corticosteroids (ICS).

METHODS: We examined 654 Czech and Slovak asthma patients who contracted COVID-19 to determine if proper use of corticosteroid inhalers was linked to a less severe course of the disease. We assessed its impact on hospitalization rates, lung function metrics, and Quality of Life (QoL).

RESULTS: In the studied cohort, 51.4% had moderate persistent asthma, 29.9% had mild persistent asthma, and 7.2% had severe persistent asthma. Poor adherence to inhaler use was significantly associated with increased COVID-19 severity (p=0.049). Proper inhaler use was associated with a lower hospitalization rate, with an odds ratio of 0.83. Post-COVID-19, vital capacity and forced expiratory lung volume in one second decreased by 3.34% and 3.6%, respectively, compared to pre-COVID-19 levels.

CONCLUSIONS: Better inhalation technique, as measured by the A-AppIT score, had a significant positive effect on reversing the decline in vital capacity (VC) and forced expiratory volume in one second (FEV1) due to COVID-19 (p=0.027 and p<0.0001, respectively). Higher A-AppIT scores were also associated with significantly improved quality of life. All measured variables showed consistent and positive improvement with better adherence. We suggest that corticosteroids help protect against lung deterioration in COVID-19 patients and that correct adherence and proper inhalation technique play a crucial role in preventing severe forms of the disease.