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Adherence to application technique of inhaled corticosteroid in patients with asthma and COVID-19 improves outcomes

Tichopád et al., BMJ Open Respiratory Research, doi:10.1136/bmjresp-2023-001874
Jan 2024  
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Budesonide for COVID-19
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*, now known with p = 0.000025 from 14 studies, recognized in 8 countries.
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Retrospective 654 asthma patients in the Czech Republic and Slovakia diagnosed with COVID-19 showing improved COVID-19 outcomes, including lower risk of hospitalization and faster recovery of lung function, with better adherence to inhaled corticosteroid (ICS) technique measured by a 5-step assessment score. Scoring higher on the assessment was associated with significantly lower COVID-19 severity after adjusting for age and asthma severity. The assessment score was also associated with higher quality of life scores after COVID-19. The results highlight the importance of proper ICS inhaler technique and adherence monitoring to optimize COVID-19 outcomes.
Tichopád et al., 6 Jan 2024, retrospective, multiple countries, peer-reviewed, mean age 61.8, 8 authors. Contact:
This PaperBudesonideAll
Adherence to application technique of inhaled corticosteroid in patients with asthma and COVID-19 improves outcomes
Aleš Tichopád, Jan Žigmond, Miloš Jeseňák, Ivan Solovič, Katarína Breciková, Marian Rybář, Martin Rožánek, Vratislav Sedlák
BMJ Open Respiratory Research, doi:10.1136/bmjresp-2023-001874
Background Inhaled corticosteroids have been widely reported as a preventive measure against the development of severe forms of COVID-19 not only in patients with asthma. Methods In 654 Czech and Slovak patients with asthma who developed COVID-19, we investigated whether the correct use of inhaler containing corticosteroids was associated with a less severe course of COVID-19 and whether this had an impact on the need for hospitalisation, measurable lung functions and quality of life (QoL). Results Of the studied cohort 51.4% had moderate persistent, 29.9% mild persistent and 7.2% severe persistent asthma. We found a significant adverse effect of poor inhaler adherence on COVID-19 severity (p=0.049). We also observed a lower hospitalisation rate in patients adequately taking the inhaler with OR of 0.83. Vital capacity and forced expiratory lung volume deterioration caused by COVID-19 were significantly reversed, by approximately twofold to threefold, in individuals who inhaled correctly. Conclusion Higher quality of inhalation technique of corticosteroids measured by adherence to an inhaled medication application technique (A-AppIT ) score had a significant positive effect on reversal of the vital capacity and forced expiratory lung volume in 1 s worsening (p=0.027 and p<0.0001, respectively) due to COVID-19. Scoring higher in the A-AppIT was also associated with significantly improved QoL. All measured variables concordantly and without exception showed a positive improvement in response to better adherence. We suggest that corticosteroids provide protection against the worsening of lungs in patients with COVID-19 and that correct and easily assessable adherence to corticosteroids with appropriate inhalation technique play an important role in preventing severe form of COVID-19. ⇒ As the importance of addressing the needs of the ageing population worldwide continues to grow, potential declines in adherence to inhalation techniques due to factors such as diminished motor skills and cognitive function may present additional challenges. Improper inhaler usage can persist unnoticed in patients over extended periods, eluding physician detection. Hence, the necessity of implementing a straightforward and all-encompassing assessment protocol during regular clinical visits becomes paramount.
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