DOI record: { "DOI": "10.1136/bmjresp-2025-003800", "ISSN": [ "2052-4439" ], "URL": "http://dx.doi.org/10.1136/bmjresp-2025-003800", "abstract": "<jats:sec>\n <jats:title>Objectives</jats:title>\n <jats:p>To assess whether fluticasone furoate (FF) use, compared with budesonide (BUD), is associated with fewer clinically detected COVID-19 events among inhaled corticosteroids (ICS) users, and to explore virus-specificity using influenza as a comparator outcome. We hypothesised that FF may provide strong local anti-inflammatory effects with limited systemic immunosuppression.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Design</jats:title>\n <jats:p>Retrospective cohort with outpatient follow-up over 4 years.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Setting</jats:title>\n <jats:p>Single Japanese medical centre.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Participants</jats:title>\n <jats:p>334 adults (102 ICS users; 232 non-ICS) followed from July 2020 to July 2024.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Main outcome measures</jats:title>\n <jats:p>Clinically detected COVID-19 (primary) and influenza (secondary). The primary exposure comparison was FF versus BUD among ICS users; ICS versus non-ICS was analysed secondarily (exploratory). Cox proportional hazards and logistic regression are adjusted for demographics, comorbidities, vaccination and systemic corticosteroids.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>Seventy-nine COVID-19 and 14 influenza events occurred. Among ICS users, FF was associated with fewer clinically detected COVID-19 events than BUD (adjusted HR 0.12, 95% CI 0.02 to 0.73; crude 6.5% vs 32.3%; Fisher’s exact p=0.0047). Under symptom-based testing, ICS users also had fewer clinically detected COVID-19 events than non-ICS users (adjusted HR 0.46, 95% CI 0.22 to 0.94), although this comparison is limited by baseline imbalance and should be interpreted as exploratory and non-causal.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>Under symptom-triggered testing, FF was associated with fewer clinically detected COVID-19 events than BUD in the head-to-head comparison among ICS users. The ICS versus non-ICS comparison is exploratory due to confounding by indication and structural imbalance. These findings are hypothesis-generating and warrant prospective studies with systematic testing and stronger designs.</jats:p>\n </jats:sec>", "accepted": { "date-parts": [ [ 2026, 3, 4 ] ] }, "alternative-id": [ "10.1136/bmjresp-2025-003800" ], "author": [ { "ORCID": "https://orcid.org/0009-0006-2143-8062", "affiliation": [ { "name": "Tsurumi Medical Center, Osaka, Japan" } ], "authenticated-orcid": false, "family": "Tsunemi", "given": "Masaki", "sequence": "first" }, { "ORCID": "https://orcid.org/0000-0002-8007-1516", "affiliation": [ { "name": "Department of Respiratory Medicine and Hematology, Hyogo Medical University, Nishinomiya, Japan" } ], "authenticated-orcid": false, "family": "Kuribayashi", "given": "Kozo", "sequence": "additional" }, { "affiliation": [ { "name": "Meijibashi Hospital, Matsubara, Japan" } ], "family": "Ishimura", "given": "Eiji", "sequence": "additional" }, { "ORCID": "https://orcid.org/0009-0004-5813-763X", "affiliation": [ { "name": "Sennansinge Clinic, Osaka, Japan" } ], "authenticated-orcid": false, "family": "Yoshinoya", "given": "Kiyokazu", "sequence": "additional" }, { "affiliation": [ { "name": "Tokyo Tower View Clinic Azabujuban, Tokyo, Japan" } ], "family": "Hayashi", "given": "Tetsuya", "sequence": "additional" }, { "affiliation": [ { "name": "Shuutetsukai MUTO CLINIC, Tokyo, Japan" } ], "family": "Muto", "given": "Toru", "sequence": "additional" }, { "affiliation": [ { "name": "Tsurumi Medical Center, Osaka, Japan" } ], "family": "Sakamoto", "given": "Hiroyuki", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-4249-4021", "affiliation": [ { "name": "Department of Respiratory Medicine and Hematology, Hyogo Medical University, Nishinomiya, Japan" } ], "authenticated-orcid": false, "family": "Kijima", "given": "Takashi", "sequence": "additional" } ], "container-title": "BMJ Open Respiratory Research", "container-title-short": "BMJ Open Resp Res", "content-domain": { "crossmark-restriction": true, "domain": [ "bmj.com" ] }, "created": { "date-parts": [ [ 2026, 4, 1 ] ], "date-time": "2026-04-01T15:35:26Z", "timestamp": 1775057726000 }, "deposited": { "date-parts": [ [ 2026, 4, 1 ] ], "date-time": "2026-04-01T15:35:29Z", "timestamp": 1775057729000 }, "indexed": { "date-parts": [ [ 2026, 4, 1 ] ], "date-time": "2026-04-01T17:37:58Z", "timestamp": 1775065078405, "version": "3.50.1" }, "is-referenced-by-count": 0, "issue": "1", "issued": { "date-parts": [ [ 2026, 4 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2026, 4, 1 ] ] }, "published-print": { "date-parts": [ [ 2026, 4 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by-nc/4.0/", "content-version": "unspecified", "delay-in-days": 0, "start": { "date-parts": [ [ 2026, 4, 1 ] ], "date-time": "2026-04-01T00:00:00Z", "timestamp": 1775001600000 } } ], "link": [ { "URL": "https://syndication.highwire.org/content/doi/10.1136/bmjresp-2025-003800", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "239", "original-title": [], "page": "e003800", "prefix": "10.1136", "published": { "date-parts": [ [ 2026, 4 ] ] }, "published-online": { "date-parts": [ [ 2026, 4, 1 ] ] }, "published-print": { "date-parts": [ [ 2026, 4 ] ] }, "publisher": "BMJ", "reference": [ { "key": "2026040108350670000_13.1.e003800.1", "unstructured": "World Health Organization . 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