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0 0.5 1 1.5 2+ Olfactory or gustatory dy.. 79% OGD Improvement Relative Risk VAS olfactory severe 97% VAS gustatory severe 95% TSS severe 83% Budesonide  Jing et al.  EARLY TREATMENT  DB RCT Is early treatment with budesonide + chlorhexidine and saline beneficial for COVID-19? Double-blind RCT 260 patients in China (May - June 2022) Lower progression (p<0.0001) and severe cases (p<0.0001) Jing et al., QJM: An Int. J. Medicine, Nov 2023 Favors budesonide Favors control

Effective early strategy to prevent olfactory and gustatory dysfunction in COVID-19: a randomized controlled trial

Jing et al., QJM: An International Journal of Medicine, doi:10.1093/qjmed/hcad262, ChiCTR2200059651
Nov 2023  
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Budesonide for COVID-19
20th treatment shown to reduce risk in April 2021
*, now known with p = 0.000025 from 14 studies, recognized in 8 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
RCT 379 mild COVID-19 cases showing significantly lower prevalence and severity of olfactory and gustatory dysfunction with budesonide nasal spray, chlorhexidine mouthwash, and saline nasal irrigation. The control group received no intervention, the saline group received saline nasal irrigation plus saline nasal spray and mouthwash, and the drug group received saline nasal irrigation plus budesonide nasal spray and chlorhexidine mouthwash. Saline nasal irrigation plus nasal spray and mouthwash were administered once and four times daily, respectively. Both treatment groups had significantly lower prevalence and severity olfactory and gustatory dysfunction. Prevalence was lower for the drug vs. saline group, without statistical significance.
This study is excluded in meta analysis: combined treatments may contribute significantly to the effect seen.
Study covers budesonide and chlorhexidine.
olfactory or gustatory dysfunction, 79.2% lower, RR 0.21, p < 0.001, treatment 10 of 120 (8.3%), control 56 of 140 (40.0%), NNT 3.2, OGD.
VAS olfactory severe, 96.5% lower, RR 0.03, p < 0.001, treatment 0 of 120 (0.0%), control 15 of 140 (10.7%), NNT 9.3, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
VAS gustatory severe, 95.3% lower, RR 0.05, p = 0.001, treatment 0 of 120 (0.0%), control 11 of 140 (7.9%), NNT 13, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
TSS severe, 83.3% lower, RR 0.17, p = 0.07, treatment 1 of 120 (0.8%), control 7 of 140 (5.0%), NNT 24.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Jing et al., 21 Nov 2023, Double Blind Randomized Controlled Trial, China, peer-reviewed, 7 authors, study period 5 May, 2022 - 16 June, 2022, this trial uses multiple treatments in the treatment arm (combined with chlorhexidine and saline) - results of individual treatments may vary, trial ChiCTR2200059651. Contact:
This PaperBudesonideAll
Effective early strategy to prevent olfactory and gustatory dysfunction in COVID-19: a randomized controlled trial
Q Jing, J Song, G An, E Zhu, Z Ai, L Xiong, C Li
Background: Olfactory and gustatory dysfunctions (OGDs) are key symptoms of coronavirus disease 2019 (COVID-19), which may lead to neurological complications, and lack of effective treatment. This may be because post-disease treatments may be too late to protect the olfactory and gustatory functions. Aim: To evaluate the effectiveness of early use of saline nasal irrigation (SNI), corticosteroid nasal spray, and saline or chlorhexidine gluconate mouthwash for preventing OGDs in COVID-19. Design: This study was a double-blind randomized controlled trial. Methods: The study was conducted from 5 May to 16 June 2022. We recruited patients from three hospitals who were admitted with COVID-19 but without OGDs on the day of admission. Olfactory and gustatory functions were evaluated using the Taste and Smell Survey and the numerical visual analog scale. Participants were randomized to the saline, drug or control groups. The control group received no intervention, saline group received SNI plus saline nasal spray and mouthwash, and the trial group received SNI plus budesonide nasal spray and chlorhexidine gluconate mouthwash. Participants were assessed again on the day of discharge. Results: A total of 379 patients completed the trial. The prevalence of OGDs was significantly lower in the saline (11.8%, 95% CI, 6.6-19.0%; P < 0.001) and drug (8.3%, 95% CI, 4.1-14.8%; P < 0.001) groups than in the control group (40.0%, 95% CI, 31.8-48.6%). Additionally, both interventions reduced the severity of OGDs. Conclusions: We demonstrated effective strategies for preventing COVID-19-related OGDs, and the findings may guide early management of severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection to reduce the incidence of COVID-19-related complications.
Conclusions We found that SNI and mouthwash were effective at preventing COVID-19-related OGDs, regardless of whether additional corticosteroids were used. These findings may guide early selfmanagement of SARS-CoV-2 infection to reduce complications and provide new insights for studies to reduce the impact of COVID-19. Supplementary material Supplementary material is available at QJMED online. Conflict of interest None declared. Author contributions
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