Abstract
Inhaled corticosteroids (IC) have been associated with an increased risk
of pneumonia in patients with Asthma and chronic obstructive pulmonary
disease (COPD). Asthmatics are at an increased risk of developing
exacerbations after infection by respiratory viruses such as Influenza
virus (IV), Parainfluenza virus, Human metapneumovirus, respiratory
syncytial virus (RSV), Rhinovirus (RV), and Human and severe acute
respiratory syndrome Coronaviruses. Asthma itself, mainly when it is
poorly controlled, is an independent risk factor for pneumonia. A subset
of Asthmatics can have significant defects in their innate, humoral, and
cell-mediated immunity arms. Despite being one of the essential drugs in
asthma control, several inhaled corticosteroids have been implicated in
the observed significantly increased incidences of pneumonia in
asthmatics. The observed association may be due to promoting viral
replication, inflammation, and impairing antiviral responses. With the
current COVID 19 pandemic affecting millions of people worldwide and
with mortality of more than 44-fold that of seasonal flu, it was
necessary to revisit this subject. Most asthmatics are poorly controlled
and are on inhaled corticosteroids, putting them in a high-risk group.
Preliminary case series have shown that asthmatics experience a more
adverse clinical course of SARS-CoV-2 infection than non-asthmatics.
Hence while we are waiting for more studies that further narrates the
association between COVID 19 and Asthma, we advise clinicians on the
importance of individualizing their management plan in asthmatics with
the main aim of achieving adequate disease control and selective use of
inhaled corticosteroids so as to avoid unwanted adverse events.