Corticosteroid use and COVID-19

Today (30th March 2020), we noticed a sharp increase in the number of visitors to a particular page of the Aspergillus Website.

The page is called ‘Medications that Weaken Your Immune System and Fungal Infections (CDC)’. We know that many people are worried and struggling to understand if and how their susceptibility to infection with SARS-CoV-2 (COVID-19) is changed by their existing medications.

It is worth noting that the article on the Aspergillus Website is written with specific reference to how medicines, such as corticosteroids and TNF (tumor necrosis factor) inhibitors, increase the risk of fungal infections. It is not written about bacterial or viral infections.

Many medications for asthma, which lots of people have in addition to allergic aspergillosis, contain corticosteroids that are inhaled. Currently, there is no evidence that people who use inhaled corticosteroids are at an increased risk of contracting COVID-19.

The Centre for Evidence-Based Medicine in Oxford has published a useful article on this subject that points out that a COVID-19 infection in an asthmatic may trigger an asthma attack, and it is of greater benefit to the patient to prevent or control that attack than it would be to stop inhaled corticosteroids in an attempt to decrease the risk of  COVID-19 infection. There is even a hint that some types of asthma medication can inhibit coronavirus infection, but the evidence is not based on COVID-19.

Many of our more severe aspergillosis patients also take oral corticosteroids to try to control their breathlessness. During flare-ups, the dose can get quite high for a short time. Needless to say, it is critically important that these patients complete the increased dose as prescribed by their doctor. Patients on long term maintenance steroids must not reduce their dose as this will not offer additional protection against COVID-19. Maintaining good control of your condition is very important in reducing risk of complications. For patients on long term steroids shielding is also particularly important.

Overall, people with chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, bronchitis or CPA are considered at increased risk of severe illness from coronavirus (COVID-19) regardless of corticosteroid use. These people should closely follow the guidance on social distancing available from Public Heath England.

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