Steroid & Immunosuppressant Medications May Pose Risk For More Severe Covid19 Infection

Steroid & Immunosuppressant Medications Pose Major Risk For Covid19 Infection
Individuals taking a class of steroid hormones called glucocorticoids (steroids) for conditions such as asthma, allergies and arthritis (or autoimmune conditions) on a routine basis may be unable to mount a normal stress response and are at higher risk if they are infected with COVID-19, according to a new editorial published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.
 
Alternatively, those who have been taking corticosteroid medication on an ongoing basis may temporarily need higher doses of their steroid medication in the event that they become infected with Covid19, and should consider discussing this with their specialists preemptively.

 

Please note that Covid19 is so new that there is no evidence that chronic use of inhaled steroids for asthma can increase the risk associated with Covid19 infection.  However, the mildly immuno-suppressive effects caused by chronic steroid use, including inhaled and intranasal steroids, have been long known.  So this is a relevant concern and a good topic to discuss with the prescribing physician or specialist.  

 
Original Research: Open access
“Our Response to COVID-19 as Endocrinologists and Diabetologists”. Ursula B Kaiser, Raghavendra G Mirmira, Paul M Stewart.
Journal of Clinical Endocrinology and Metabolism doi:10.1210/clinem/dgaa148
 
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This Post Has 2 Comments

  1. Tami Rockholt

    that is a bit scary since I have asthma –

    1. Justin Groode

      Yes, this is a bit of a conundrum for asthmatics using daily inhaled steroids. The article was actually written by endocrinologists dealing with chronic adrenal insufficiency secondary to taking long term oral corticosteroids, in which cases the dose of the steroid would actually need to be increased during an infection or illness. However, in the case of asthma, the low dose of inhaled steroid does not suppress adrenal production of cortisol (our stress hormone), so this is not a concern. The concern with asthmatics has to do with chronic mild immune system suppression, in particular the local immune system of the nasopharyngeal and respiratory system. Asthmatics are not told to stop using inhaled steroids during flu season, so it would be counterintuitive to make such a recommendation for another seasonal respiratory viral threat, as is the case with SARS-CoV2. However, given what we are seeing with Covid19’s predilection for lung tissue, it is a bit worrisome to have mildly suppressed lung immunity while trying to fight this new virus. On the other hand, asthma itself is a serious condition for many people, which can be amplified tremendously by viral respiratory infections. Hence, we need to weigh the risks and benefits of each scenario.

      An example of someone who might consider coming off of their steroid inhaler (with the clearance of their physician) might be a mild to moderate asthmatic who can control asthma symptoms quite well with only an anti-histamine medication to control allergies and irregular use of an albuterol (rescue) inhaler. Alternatively, an example of someone who probably should not consider a break from their steroid inhaler would be a moderate to severe asthmatic who would not be able to control symptoms without the inhaled steroids. Having said that, it might be worth a discussion with one’s physician about reducing the dose of the steroid to the lowest effective dose, perhaps with some permissive breakthrough symptoms that can be easily controlled with albuterol.

      As you can see, this is a complex and highly individualized discussion with few obvious correct or incorrect answers. From an integrative medicine perspective, inhaled glutathione is a little known option for this situation. Glutathione is the body’s main antioxidant, produced in the liver, kidney, and various other tissues of the body. Inhaling (nebulizing) glutathione could potentially offer some local antioxidant and anti-inflammatory protection in the lung and airways, both for prevention as well as an adjunct to treatment. I pasted an NCBI report that I found in 4 seconds on google pertaining to glutathione inhalation (below). There isn’t much literature because glutathione is an amino acid complex made within the body so would not likely be something studied by the pharma industry. I contend that it is inexpensive and could potentially prove useful as an adjunct therapy in the age of Covid19.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249747

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