: Clinical Outcomes after Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Clinic Cohort: A Retrospective Chart Review

JMIR Form Res. 2022 Dec 1. doi: 10.2196/36023. Online ahead of print.

Abstract

Background: Coronavirus disease 2019 (COVID-19) concerns remains among healthcare providers as there are few outpatient treatment options. As this was the early days of the pandemic and treatment options for non-hospitalized patients were limited, symptomatic treatment and home-grown guidelines which utilized recommendations from the Global Initiative for Asthma Management and Treatment (GINA 2020) were utilized.

Objective: The possibility that ICS might reduce the risk of respiratory symptoms and promote recovery was the impetus for the review as it had already been shown that in the non-hospitalized patient population, OCS in the acute phase could have an adverse effect on recovery. We investigate if (1) patients treated with ICS are less likely to require referral to a post-COVID clinic or pulmonary specialist than patients without ICS treatment or that received OCS therapy, and (2) if OSC use is associated with worse health outcomes.

Methods: Using a retrospective chart review method, we identified all patients with acute illness due to COVID-19 that were followed and managed by a telemedicine clinic team between June and December 2020. The data was electronically pulled from the electronic medical record (EMR) through April 2021 and reviewed to determine which patients eventually required referral to a post COVID clinic or pulmonary specialist due to persistent respiratory symptoms of COVID-19. The data was then analyzed to compare outcomes between those prescribed OCS and those prescribed ICS. We specifically looked at patients treated acutely with ICS or OCS that then required referral to a pulmonary specialist or post-COVID clinic. We excluded any patient with a history of chronic OCS or ICS use for any reason.

Results: Prescribing ICS during the acute phase did not reduce the possibility of developing persistent symptoms. There was no difference in the referral rate to a pulmonary specialist or post COVID clinic between those treated with OCS versus ICS. However, our data may not be generalizable to other populations as it represents a patient population enrolled in a telemedicine program at a single center.

Conclusions: We found ICS, as compared to OCS, did not reduce the risk of developing persistent respiratory symptoms. This finding adds to the body of knowledge that ICS & OCS medications remain a potent treatment in patient with acute and post-acute COVID-19 seen in an outpatient setting.