Regular Inhaled Corticosteroids Use May Protect Against Severe COVID-19 Outcome in COPD

Int J Chron Obstruct Pulmon Dis. 2023 Aug 7:18:1701-1712. doi: 10.2147/COPD.S404913. eCollection 2023.


Purpose: Population-based studies provide conflicting evidence about how inhaled corticosteroids (ICS) impact COVID-19 outcomes among COPD patients. We investigated whether regular ICS exposure affects risk, severity, or survival in SARS-CoV-2 infection, using a nationwide linked Swedish population register database.

Patients and methods: During January-December 2020, we studied two defined Swedish adult populations - Whole population [≥40 years] (N = 5243479), and COPD subpopulation [≥40 years] (N = 133372), in three study cohorts, respectively: 1. Overall cohort (index date 1 Jan 2020), 2. COVID-19 diagnosed sub-cohort (index date = diagnosis date), and 3. COVID-19 hospitalized sub-cohort (index date = admission date). Regular exposure was defined as ≥3 ICS prescriptions in the year before index. Hazard ratios (HRs) for outcomes (COVID-19 onset, hospitalization, ICU admission, or death) related to ICS exposure were estimated using Cox regression. Confounding was controlled by propensity score methods applying Average Treatment effect in the Treated (ATT) weighting.

Results: Regular ICS use was associated with only very slightly increased onset of COVID-19, hospitalization, ICU admission, and death in the overall whole population cohort and in the overall COPD subpopulation cohort, except for ICU admission (marginally non-significant HRs, up to 1.13); and no clear increase in the diagnosed sub-cohorts. However, in the COVID-19 hospitalized COPD sub-cohort, ICS therapy showed reduced risks against progression to ICU admission and death, significant for death (HR 0.82 95% CI [0.67-0.99]).

Conclusion: For COPD patients, ICS therapy offers some protection against progression to ICU admission and death among COVID-19 hospitalized patients. Our findings alleviate concerns about increased risks of COVID-19 by ICS treatment and provide evidence supporting the continuation of ICS therapy for COPD patients.

Keywords: COPD; COVID −19; mortality.

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones
  • Adult
  • COVID-19* / complications
  • Humans
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / drug therapy
  • Pulmonary Disease, Chronic Obstructive* / epidemiology
  • SARS-CoV-2


  • Adrenal Cortex Hormones

Grants and funding

The SCIFI-PEARL study has basic funding based on grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (grants ALFGBG-938453, ALFGBG-971130, ALFGBG-978954,) and previously from FORMAS (Research Council for Environment, Agricultural Sciences and Spatial Planning), a Swedish Research Council for Sustainable Development (grant 2020-02828). This research was also based on support from the Swedish Heart-Lung Foundation (20210030, 20210581).