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Budesonide for COVID-19
15 studies with >20,000 patients
Serious outcome risk
Budesonide
Control
Significantly lower risk for mortality, ICU, hospitalization, progression, recovery, and cases.
40% lower risk in 7 RCTs CI -8-67%
COVID-19 Budesonide studies · October 2026
Inhaler technique and adherence may significantly affect outcomes1. Budesonide was adopted in 10 countries. Recent:
Strub-Wourgaft
Tyson
Tsunemi.
Covid Analysis Budesonide reduces COVID-19 risk: real-time meta-analysis of 15 studies (Version 33)
Significantly lower risk is seen for mortality, ICU admission, hospitalization, progression, recovery, and cases. 10 studies from 10 independent teams in 6 countries show significant benefit. Meta-analysis using the most serious outcome r..
Apr 1
 Tsunemi et al., BMJ Open Respiratory Research, doi:10.1136/bmjresp-2025-003800 Differential association of fluticasone furoate and budesonide with clinically detected COVID-19: a retrospective cohort study
Retrospective 334 outpatients (102 ICS users, 232 non-ICS users) over 4 years at a single Japanese center, showing lower COVID-19 cases with fluticasone furoate compared to budesonide, and lower cases for ICS users vs. non-ICS users.
Jul 22
2025
 Gong et al., BMC Pulmonary Medicine, doi:10.1186/s12890-025-03824-5 Efficacy and safety of combined nebulization of unfractionated heparin, acetylcysteine, budesonide and ipratropium bromide in hospitalised patients with COVID-19 pneumonia: a randomized controlled clinical trial
RCT 74 hospitalized COVID-19 pneumonia patients showing improved lung lesion absorption and oxygenation with combined nebulization of unfractionated heparin, acetylcysteine, budesonide, and ipratropium bromide. The treatment group demonst..
Mar 14
2025
 Moustafa et al., Pharmaceuticals, doi:10.3390/ph18030412 Evaluating the Use of Inhaled Budesonide and Ipratropium Bromide Combination in Patients at High Risk of Acute Respiratory Distress Syndrome Development: A Randomized Controlled Trial
Non-COVID-19 RCT with 119 hospitalized patients at high risk of acute respiratory distress syndrome (ARDS) showing significantly lower rates of ARDS and mechanical ventilation with inhaled budesonide + ipratropium bromide treatment.
May 30
2024
 Bai et al., The Clinical Respiratory Journal, doi:10.1111/crj.13790 COPD patients with high blood eosinophil counts exhibit a lower rate of omicron infection and milder post‐infection symptoms
31% lower hospitalization (p=0.18) and 24% fewer cases (p=0.0001). Retrospective 315 COPD patients in China showing significantly lower COVID-19 cases with budesonide/formoterol or budesonide/glycopyrronium/formoterol use. Note that Table 4 includes only infected patients, we show the COVID-19 hospitaliz..
Mar 28
2024
 Strub-Wourgaft et al., ANTICOV An open-label, multicentre, randomised, adaptive platform trial of the safety and efficacy of several therapies, including antiviral therapies, versus control in mild/moderate cases of COVID-19
91% lower progression (p=0.37) and 5% lower hospitalization (p=1). RCT 1,942 patients testing HCQ, lopinavir/ritonavir, nitazoxanide/ciclesonide, ivermectin/ASAQ, and fluoxetine/budesonide compared wirth paracetamol. Control patients were assigned to paracetamol as needed for fever or pain, however treat..
Feb 28
2024
 Gerayeli et al., medRxiv, doi:10.1101/2024.02.26.24302674 Single cell sequencing reveals cellular landscape alterations in the airway mucosa of patients with pulmonary long COVID
Single-cell RNA sequencing study of airway cells from patients with persistent respiratory symptoms due to COVID-19 infection (pulmonary long COVID) over 1 year after initial infection. Authors found increased neutrophils and neutrophil a..
Jan 6
2024
 Tichopád et al., BMJ Open Respiratory Research, doi:10.1136/bmjresp-2023-001874 Adherence to application technique of inhaled corticosteroid in patients with asthma and COVID-19 improves outcomes
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 inhale..
Dec 14
2023
 Mettananda et al., BMJ Open, doi:10.1136/bmjopen-2023-075803 Inhaled beclomethasone in the treatment of early COVID-19: a double-blind, placebo-controlled, randomised, hospital-based trial in Sri Lanka
RCT 385 asymptomatic, mild or moderate COVID-19 patients in Sri Lanka showing no significant difference in progression to severe disease with inhaled beclomethasone. There was a reduction in time to clinical recovery in patients initially..
Nov 28
2023
 Yu et al., PLOS ONE, doi:10.1371/journal.pone.0294872 Clinical efficacy of inhaled corticosteroids in patients with coronavirus disease 2019: A living review and meta-analysis
55% lower hospitalization (p=0.26) and 25% improved recovery (p<0.0001). Systematic review and meta-analysis of 8 randomized controlled trials (2,788 patients) comparing inhaled corticosteroids (ICS) to placebo or usual care for the treatment of COVID-19. Overall, ICS treatment was associated with improved cli..
Nov 27
2023
 Jeong, S., Open Forum Infectious Diseases, doi:10.1093/ofid/ofad500.600 Clinical efficacy of inhaled corticosteroids in patients with coronavirus disease-2019: an updated systematic review and meta-analysis
25% improved recovery (p<0.0001). Systematic review and meta analysis showing improved recovery with budesonide.
Nov 21
2023
 Jing et al., QJM: An International Journal of Medicine, doi:10.1093/qjmed/hcad262 Effective early strategy to prevent olfactory and gustatory dysfunction in COVID-19: a randomized controlled trial
79% lower progression (p<0.0001) and 97% lower severe cases (p<0.0001). 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 interv..
Nov 1
2023
 Yong et al., Frontiers in Pharmacology, doi:10.3389/fphar.2023.1204297 Associations between COVID-19 outcomes and asthmatic patients with inhaled corticosteroid
PSM retrospective 64,587 asthmatic patients using inhaled corticosteroids (ICS) and 64,587 matched controls without ICS use. ICS medications included budesonide, mometasone, flunisolide, beclomethasone, fluticasone, and ciclesonide. ICS u..
Sep 30
2023
 Dhanger et al., International Journal of Academic Medicine and Pharmacy, doi:10.47009/jamp.2023.5.5.101 To estimate the efficacy of inhaled corticosteroid in-patient of moderate COVID-19 pneumonia - randomized controlled study
43% lower mortality (p=0.52), 78% lower ICU admission (p<0.0001), and 70% improved recovery (p<0.0001). RCT inhaled budesonide with 80 moderate COVID-19 pneumonia patients. The budesonide group had significantly faster time to clinical improvement, fewer ICU admissions, shorter oxygen therapy duration, and lower mortality. Inhaled budesonid..
Aug 31
2023
 Hautefort et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2023.08.022 Local budesonide therapy in the management of persistent hyposmia in suspected non-severe COVID-19 patients: Results of a randomized controlled trial
RCT 123 post-COVID-19 hyposmia patients, showing no significant difference in smell recovery with budesonide. 2 patients experienced improvement of more than two points on the ODORATEST score compared with 0 in the control group.
Aug 2
2023
 Winn et al., PLOS ONE, doi:10.1371/journal.pone.0288285 Effect of any form of steroids in comparison with that of other medications on the duration of olfactory dysfunction in patients with COVID-19: A systematic review of randomized trials and quasi-experimental studies
Review of the effects of various treatment options and interventions for COVID-19-related olfactory dysfunction. Authors analyzed 21 studies with a total of 130,550 patients to compare the efficacy of corticosteroid treatments with other ..
Aug 1
2023
 Marcy et al., NCT04920838 Early Treatment of Vulnerable Individuals With Non-Severe SARS-CoV-2 Infection: A Multi-Arm Multi-Stage Randomized Trial (MAMS) to Evaluate the Effectiveness of Several Specific Treatments in Reducing the Risk of Clinical Worsening or Death in Sub-Saharan Africa (COVERAGE-Africa)
Estimated 600 patient budesonide early treatment RCT with results not reported over 3 years after estimated completion.
Apr 17
2023
 Reis et al., Annals of Internal Medicine, doi:10.7326/M22-3305 Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19
12% lower hospitalization (p=1) and 50% lower progression (p=0.04). Low-risk (1% hospitalization) outpatient RCT with 738 fluvoxamine + budesonide patients and 738 placebo patients, showing significantly lower hospitalization/ER visits with treatment.
Mar 3
2023
 Samajdar et al., Lung India, doi:10.4103/lungindia.lungindia_268_22 Effectiveness of budesonide formoterol fixed-dose combination MDI in reducing cough symptoms in COVID-19 patients: A real-world evidence study
69% lower hospitalization (p=0.07) and 29% improved recovery (p=0.008). Prospective study of 102 patients in India, showing improved recovery of cough with budesonide+formoterol. Authors note better results with earlier treatment. Budesonide 800mcg + formoterol 12mcg bid for 7 days.
Nov 1
2022
 Korea United Pharm., NCT05055414 A Multi-center, Randomized, Double-blind, Placebo-controlled, Parallel, Phase 2 Study to Evaluate the Efficacy and Safety of UI030 in COVID-19 Patients
Estimated 140 patient budesonide early treatment RCT with results not reported over 3 years after estimated completion.
Aug 31
2022
 Yang et al., Open Medicine, doi:10.1515/med-2022-0569 The relationship between oxygen therapy, drug therapy, and COVID-19 mortality
11% higher mortality (p=0.85). Retrospective 185 hospitalized COVID-19 patients in China, showing no significant difference in mortality with budesonide use in unadjusted results.
Aug 16
2022
 Loucera et al., Virology Journal, doi:10.1186/s12985-023-02195-9 (date from preprint) Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments
22% lower mortality (p=0.004). Retrospective 15,968 COVID-19 hospitalized patients in Spain, showing lower mortality with existing use of several medications including metformin, HCQ, azithromycin, aspirin, vitamin D, vitamin C, and budesonide. Since only hospitalized ..
Apr 18
2022
 Gavriilidis et al., Clinical Immunology, doi:10.1016/j.clim.2022.109016 Combined administration of inhaled DNase, baricitinib and tocilizumab as rescue treatment in COVID-19 patients with severe respiratory failure
74% lower mortality (p=0.05), 76% lower ventilation (p=0.02), and 20% shorter hospitalization (p=0.02). Small retrospective study of hospitalized patients with severe respiratory failure, 22 treated with a combination of budesonide, tocilizumab, baricitinib, dornase alfa, and salbutamol or/and ipratropium, and 26 SOC patients, showing lower..
Mar 22
2022
 Bhandari et al., International Journal of Scientific Development and Research, 7:3 Effectiveness of Inhaled Steroids in Post COVID Cough
33% lower need for oxygen therapy (p=0.009), 26% shorter hospitalization (p=0.02), and 37% faster recovery (p=0.001). Retrospective 120 hospitalized COVID-19 patients with persistent cough in India, showing faster resolution of cough, shorter duration of oxygen support, and shorter hospitalization with inhaled budesonide treatment compared to standard of..
Mar 16
2022
 Duvignaud et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2022.02.031 Inhaled ciclesonide for outpatient treatment of COVID-19 in adults at risk of adverse outcomes: a randomised controlled trial (COVERAGE)
80% lower mortality (p=0.24), 36% higher hospitalization (p=0.52), and 20% higher progression (p=0.69). Early terminated RCT with 110 ciclesonide patients and 107 patients treated with vitamins A, B1, B2, B3, B5, B6, B8, B9, B12, C, D3, and E, calcium, chromium, copper, iron, manganese, molybdenum, selenium, and zinc (Azinc Vitality), show..
Feb 10
2022
 Agustí et al., European Respiratory Journal, doi:10.1183/13993003.03036-2021 Add-on inhaled budesonide in the treatment of hospitalised patients with COVID-19: a randomised clinical trial
23% higher mortality (p=1) and 39% lower progression (p=0.69). Small early-terminated RCT with 40 inhaled budesonide and 49 control patients, showing no significant differences. 400µg/12h via Pulmicort Turbuhaler.
Jan 13
2022
 Tyson et al., Journal of Independent Medicine, doi:10.71189/JIM/2025/V01N02A06 (date from preprint) Low Rates of Hospitalization and Death in 4376 COVID-19 Patients Treated With Early Ambulatory Medical and Supportive Care: A Case Series and Observational Study
98% lower mortality (p<0.0001) and 99% lower hospitalization (p<0.0001). Retrospective 4,376 patients with mild/moderate COVID-19 in the USA treated with multiple medications including HCQ/ivermectin, zinc, azithromycin, budesonide, and dexamethasone (exact treatments specific to each patient), showing signifi..
Jan 8
2022
 Monserrat Villatoro et al., Pharmaceuticals, doi:10.3390/ph15010078 A Case-Control of Patients with COVID-19 to Explore the Association of Previous Hospitalisation Use of Medication on the Mortality of COVID-19 Disease: A Propensity Score Matching Analysis
49% lower mortality (p=0.01). PSM retrospective 3,712 hospitalized patients in Spain, showing lower mortality with existing use of azithromycin, bemiparine, budesonide-formoterol fumarate, cefuroxime, colchicine, enoxaparin, ipratropium bromide, loratadine, mepyramine..
Dec 31
2021
 Alsultan et al., Interdisciplinary Perspectives on Infectious Diseases, doi:10.1155/2021/2129006 Efficacy of Colchicine and Budesonide in Improvement Outcomes of Patients with Coronavirus Infection 2019 in Damascus, Syria: A Randomized Control Trial
7% higher mortality (p=1) and 20% shorter hospitalization. Small RCT 49 severe condition hospitalized patients in Syria, showing lower mortality with colchicine and shorter hospitalization time with both colchicine and budesonide (all of these are not statistically significant).
Nov 22
2021
 Clemency et al., JAMA Internal Medicine, doi:10.1001/jamainternmed.2021.6759 Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19
54% lower hospitalization (p=0.26), 81% fewer combined hospitalization/ER visits (p=0.03), and 15% improved recovery (p=0.25). RCT 400 outpatients in the USA, showing significantly lower ER visits/hospital admission with ciclesonide treatment. NCT04377711. Publication was delayed about a year after completion and the primary endpoint was changed about 4 months af..
Nov 10
2021
 Al Sulaiman et al., Journal of Intensive Care Medicine, doi:10.1177/08850666211053548 The Role of Inhaled Corticosteroids (ICS) in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study
32% lower mortality (p=0.13). Combined retrospective (Mar-Jun 2020) and prospective (until Mar 2021) study of 954 COVID+ ICU patients in Saudi Arabia, 68 treated with ICS (80% budesonide or budesonide/formoterol, 20% fluticasone/salmeterol), showing lower mortality wi..
Oct 27
2021
 Baker et al., medRxiv, doi:10.1101/2021.10.26.21265512 Dampening of the respiratory cytokine storm is promoted by inhaled budesonide in patients with early COVID-19
Analysis of inflammatory mediators in the nasal mucosa of patients in the STOIC1 trial and a cohort of SARS-CoV-2 negative controls, showing that budesonide treatment decreased IL-33 and IFN-γ, implying a reduction in epithelial damage an..
Sep 9
2021
 Lee et al., Research Square, doi:10.21203/rs.3.rs-72221/v1 Association Between Inhaled Corticosteroid Use and the Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Nationwide Population-based Study in South Korea
33% fewer cases (p=0.1). Retrospective 44,968 patients in South Korea, 7,019 on inhaled corticosteroids, showing no statistically significant differences in COVID-19 cases.
Aug 23
2021
 Strauss et al., The Journal of Allergy and Clinical Immunology: In Practice, doi:10.1016/j.jaip.2021.08.007 Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019
24% lower mortality (p=0.01), 22% lower ICU admission (p=0.003), and 19% lower hospitalization (p<0.0001). Retrospective 72,147 COVID-19+ patients in the USA, showing lower mortality, ICU admission, and hospitalization with intranasal corticosteroid use.
Jul 20
2021
 Heinen et al., Viruses, doi:10.3390/v13071411 Antiviral Effect of Budesonide against SARS-CoV-2
In vitro study showing dose-dependent inhibition of SARS-CoV-2 with budesonide.
Jun 18
2021
 Hayward et al., BMJ Open, doi:10.1136/bmjopen-2020-046799 Platform Randomised trial of INterventions against COVID-19 In older peoPLE (PRINCIPLE): protocol for a randomised, controlled, open-label, adaptive platform, trial of community treatment of COVID-19 syndromic illness in people at higher risk
Protocol paper for the PRINCIPLE trial. For the colchicine arm see [Dorward], for budesonide see [Yu], and for ivermectin see [Hayward].
May 31
2021
 Singh et al., American Journal of Otolaryngology, doi:10.1016/j.amjoto.2020.102892 The outcome of fluticasone nasal spray on anosmia and triamcinolone oral paste in dysgeusia in COVID-19 patients
Prospective study of 120 COVID-19 patients in India showing significant improvements in smell and taste with fluticasone nasal spray and triamcinolone oral paste. In the treatment group, smell and taste significantly improved by day 5 com..
May 28
2021
 Taille et al., NCT04331054 Protective Role of Inhaled Steroids for Covid-19 Infection
146 patient budesonide late treatment RCT with results not reported over 5 years after completion.
May 5
2021
 Konduri et al., bioRxiv, doi:10.1101/2021.05.05.442779 ProLung™-budesonide Inhibits SARS-CoV-2 Replication and Reduces Lung Inflammation
In vitro study and animal study showing that ProLung™-budesonide inhibits SARS-CoV-2 replication (results for budesonide were not provided). ProLung™-budesonide and budesonide significantly decreased lung inflammation. ProLung™-budesonide..
Apr 12
2021
 Yu et al., The Lancet, doi:10.1016/S0140-6736(21)01744-X (date from preprint) Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial
39% lower mortality (p=0.45), 6% lower ventilation (p=1), 52% lower ICU admission (p=0.07), and 25% lower combined mortality/hospitalization (p=0.96). Results from the PRINCIPLE trial, 1,073 treated with budesonide starting a median of 6 days after symptom onset, showing lower hospitalization/death, and faster recovery with treatment.
Mar 30
2021
 Holt et al., Thorax, doi:10.1136/thoraxjnl-2021-217487 Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK)
32% fewer cases (p=0.03). Prospective survey-based study with 15,227 people in the UK, showing lower risk of COVID-19 cases with vitamin A, vitamin D, zinc, selenium, probiotics, and inhaled corticosteroids; and higher risk with metformin and vitamin C. Statistica..
Feb 8
2021
 Ramakrishnan et al., Lancet Respiratory Medicine, doi:10.1016/S2213-2600(21)00160-0 (date from preprint) Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial
82% fewer combined hospitalization/ER visits (p=0.02) and 67% improved recovery (p=0.003). RCT with 73 budesonide patients and 73 control patients, showing significantly lower combined risk of an ER visit or hospitalization, and lower risk of no recovery at day 14.
Oct 18
2020
 Ramlall et al., medRxiv, doi:10.1101/2020.10.15.20213546 Melatonin is significantly associated with survival of intubated COVID-19 patients
71% lower mortality (p=0.01). Retrospective 948 intubated patients, 33 treated with budesonide, showing lower mortality with treatment. Results are subject to immortal time bias and confounding by indication. Budesonide is an inhaled corticosteroid typically prescribe..
May 20
2020
 Afazeli et al., NCT04331470 Evaluation of Efficacy of Pharmacotherapy Treatment of COVID-19 Infection Using Oral Levamisole and Formoterol+Budesonide Inhaler and Comparison of This Treatment Protocol With Standard National Treatment of the Disease
Estimated 30 patient budesonide early treatment RCT with results not reported over 6 years after estimated completion.
References