Association between inhaled corticosteroid use and COVID-19 outcomes

Pharmacoepidemiol Drug Saf. 2021 Nov;30(11):1486-1492. doi: 10.1002/pds.5345. Epub 2021 Aug 24.


Background: Recent evidence has established a beneficial effect of systemic corticosteroids for treatment of moderate-to-severe COVID-19.

Objective: To determine if inhaled corticosteroid use is associated with COVID-19 outcomes.

Methods: In a nationwide cohort of hospitalized SARS-CoV-2 test-positive individuals in Denmark, we estimated the 30-day hazard ratio of intensive care unit (ICU) admission or death among users of inhaled corticosteroids (ICS) compared with users of bronchodilators (β2 -agonist/muscarinic-antagonists), and non-users of ICS overall, with Cox regression adjusted for age, sex, and other confounders. We repeated these analyses among influenza test-positive patients during 2010-2018.

Results: Among 6267 hospitalized SARS-CoV-2 patients, 614 (9.8%) were admitted to ICU and 677 (10.8%) died within 30 days. ICS use was associated with a hazard ratio of 1.09 (95% CI [CI], 0.67 to 1.79) for ICU admission and 0.78 (95% CI, 0.56 to 1.11) for death compared with bronchodilator use. Compared with no ICS use overall, the hazard ratio of ICU admission or death was 1.17 (95% CI, 0.87-1.59) and 1.02 (95% CI, 0.78-1.32), respectively. Among 10 279 hospitalized influenza patients, of which 951 (9.2%) were admitted to ICU and 1275 (12.4%) died, the hazard ratios were 1.43 (95% CI, 0.89-2.30) and 1.11 (95% CI, 0.85-1.46) for ICU admission, and 0.80 (95% CI, 0.63-1.01) and 1.03 (95% CI, 0.87-1.22) for death compared with bronchodilator use and no ICS use overall, respectively.

Conclusion: Our results do not support an effect of inhaled corticosteroid use on COVID-19 outcomes, however we can only rule out moderate-to-large reduced or increased risks.

Study registration: The study was pre-registered at (EUPAS35897).

Keywords: COVID-19; cohort study; inhaled corticosteroids; pharmacoepidemiology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • COVID-19*
  • Hospitalization
  • Humans
  • Intensive Care Units
  • SARS-CoV-2


  • Adrenal Cortex Hormones