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Association between Inhaled Corticosteroid Use and SARS-CoV-2 Infection: A Nationwide Population-Based Study in South Korea

  • Lee, Sang Chul (Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital) ;
  • Son, Kang Ju (Department of Research and Analysis, National Health Insurance Service Ilsan Hospital) ;
  • Han, Chang Hoon (Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital) ;
  • Jung, Ji Ye (Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Seon Cheol (Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital)
  • 투고 : 2021.07.01
  • 심사 : 2021.11.24
  • 발행 : 2022.01.31

초록

Background: Although it is known that inhaled corticosteroid (ICS) use may increase the risk of respiratory infection, its influence on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Thus, the aim of this study was to investigate the association between ICS use and the positivity of SARS-CoV-2 infection among patients with chronic respiratory diseases. Methods: Nationwide data of 44,968 individuals with chronic respiratory diseases tested for SARS-CoV-2 until May 15, 2021 were obtained from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The positivity of SARS-CoV-2 infection was retrospectively analysed according to the prescription, type, and dose of ICS taken one year before SARS-CoV-2 test. Results: Among 44,968 individuals tested, 931 (2.1%) were positive for SARS-CoV-2. A total of 7,019 patients (15.6%) were prescribed ICS one year prior to being tested for SARS-CoV-2. Low, medium, and high doses of ICS were prescribed in 7.5%, 1.6%, and 6.5% of total cases, respectively. Among types of ICS, budesonide, fluticasone, beclomethasone, and ciclesonide were prescribed in 3.7%, 8.9%, 2.3%, and 0.6% of total cases, respectively. A multivariate analysis showed no significant increase in infection with ICS use (odds ratio, 0.84; 95% confidence interval, 0.66-1.03). Moreover, there were no associations between the positivity of infection and the dose or type of ICS prescribed. Conclusion: Prior ICS use did not increase the positivity for SARS-CoV-2 infection. Moreover, different doses or types of ICS did not affect this positivity.

키워드

과제정보

The authors appreciate the contribution of healthcare professionals dedicated to treating SARS-CoV-2 patients in Korea and the Ministry of Health and Welfare and the Health Insurance Review & Assessment Service of Korea for sharing invaluable national health insurance claims data in a prompt manner.

참고문헌

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020;382:727-33. https://doi.org/10.1056/NEJMoa2001017
  2. World Health Organization. Coronavirus disease (COVID-2019) situation reports. Geneva: World Health Organization; 2020.
  3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-13. https://doi.org/10.1016/s0140-6736(20)30211-7
  4. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20. https://doi.org/10.1056/NEJMoa2002032
  5. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis 2020;94:91-5. https://doi.org/10.1016/j.ijid.2020.03.017
  6. Kew KM, Seniukovich A. Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014;(3):CD010115.
  7. McKeever T, Harrison TW, Hubbard R, Shaw D. Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case-control study. Chest 2013;144:1788-94. https://doi.org/10.1378/chest.13-0871
  8. Kim MH, Rhee CK, Shim JS, Park SY, Yoo KH, Kim BY, et al. Inhaled corticosteroids in asthma and the risk of pneumonia. Allergy Asthma Immunol Res 2019;11:795-805. https://doi.org/10.4168/aair.2019.11.6.795
  9. Lee CH, Kim K, Hyun MK, Jang EJ, Lee NR, Yim JJ. Use of inhaled corticosteroids and the risk of tuberculosis. Thorax 2013;68:1105-13. https://doi.org/10.1136/thoraxjnl-2012-203175
  10. Andrejak C, Nielsen R, Thomsen VO, Duhaut P, Sorensen HT, Thomsen RW. Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis. Thorax 2013;68:256-62. https://doi.org/10.1136/thoraxjnl-2012-201772
  11. Lam WY, Fresco P. Medication adherence measures: an overview. Biomed Res Int 2015;2015:217047.
  12. Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J 2015;45:396-407. https://doi.org/10.1183/09031936.00075614
  13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  14. Global Initiative for Asthma. Global strategy for asthma management and prevention. Fontana: Global Initiative for Asthma; 2020.
  15. Suissa S, McGhan R, Niewoehner D, Make B. Inhaled corticosteroids in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007;4:535-42. https://doi.org/10.1513/pats.200701-024FM
  16. Yang M, Chen H, Zhang Y, Du Y, Xu Y, Jiang P, et al. Long-term use of inhaled corticosteroids and risk of upper respiratory tract infection in chronic obstructive pulmonary disease: a meta-analysis. Inhal Toxicol 2017;29:219-26. https://doi.org/10.1080/08958378.2017.1346006
  17. Yang M, Zhang Y, Chen H, Lin J, Zeng J, Xu Z. Inhaled corticosteroids and risk of upper respiratory tract infection in patients with asthma: a meta-analysis. Infection 2019;47:377-85. https://doi.org/10.1007/s15010-018-1229-y
  18. Singanayagam A, Glanville N, Girkin JL, Ching YM, Marcellini A, Porter JD, et al. Corticosteroid suppression of antiviral immunity increases bacterial loads and mucus production in COPD exacerbations. Nat Commun 2018;9:2229. https://doi.org/10.1038/s41467-018-04574-1
  19. O'Byrne PM, Pedersen S, Carlsson LG, Radner F, Thoren A, Peterson S, et al. Risks of pneumonia in patients with asthma taking inhaled corticosteroids. Am J Respir Crit Care Med 2011;183:589-95. https://doi.org/10.1164/rccm.201005-0694OC
  20. Brode SK, Campitelli MA, Kwong JC, Lu H, Marchand-Austin A, Gershon AS, et al. The risk of mycobacterial infections associated with inhaled corticosteroid use. Eur Respir J 2017;50:1700037. https://doi.org/10.1183/13993003.00037-2017
  21. Liao SY, Petrache I, Fingerlin TE, Maier LA. Association of inhaled and systemic corticosteroid use with Coronavirus Disease 2019 (COVID-19) test positivity in patients with chronic pulmonary diseases. Respir Med 2021;176:106275. https://doi.org/10.1016/j.rmed.2020.106275
  22. Kow CS, Hasan SS. Preadmission use of inhaled corticosteroids and risk of fatal or severe COVID-19: a meta-analysis. J Asthma 2021 Feb 8 [Epub]. https://doi.org/10.1080/02770903.2021.1878531.
  23. Bloom CI, Drake TM, Docherty AB, Lipworth BJ, Johnston SL, Nguyen-Van-Tam JS, et al. Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK. Lancet Respir Med 2021;9:699-711. https://doi.org/10.1016/S2213-2600(21)00013-8
  24. Yan R, Zhang Y, Li Y, Xia L, Guo Y, Zhou Q. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science 2020;367:1444-8. https://doi.org/10.1126/science.abb2762
  25. Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020;181:271-80. https://doi.org/10.1016/j.cell.2020.02.052
  26. Peters MC, Sajuthi S, Deford P, Christenson S, Rios CL, Montgomery MT, et al. COVID-19-related genes in sputum cells in asthma: relationship to demographic features and corticosteroids. Am J Respir Crit Care Med 2020;202:83-90. https://doi.org/10.1164/rccm.202003-0821OC
  27. Iwabuchi K, Yoshie K, Kurakami Y, Takahashi K, Kato Y, Morishima T. Therapeutic potential of ciclesonide inahalation for COVID-19 pneumonia: report of three cases. J Infect Chemother 2020;26:625-32. https://doi.org/10.1016/j.jiac.2020.04.007
  28. Halpin DM, Faner R, Sibila O, Badia JR, Agusti A. Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection? Lancet Respir Med 2020;8:436-8. https://doi.org/10.1016/s2213-2600(20)30167-3
  29. Matsuyama S, Kawase M, Nao N, Shirato K, Ujike M, Kamitani W, et al. The inhaled corticosteroid ciclesonide blocks coronavirus RNA replication by targeting viral NSP15. Preprint at https://doi.org/10.1101/2020.03.11.987016 (2020).
  30. Yamaya M, Nishimura H, Deng X, Sugawara M, Watanabe O, Nomura K, et al. Inhibitory effects of glycopyrronium, formoterol, and budesonide on coronavirus HCoV-229E replication and cytokine production by primary cultures of human nasal and tracheal epithelial cells. Respir Investig 2020;58:155-68. https://doi.org/10.1016/j.resinv.2019.12.005
  31. Janson C, Stratelis G, Miller-Larsson A, Harrison TW, Larsson K. Scientific rationale for the possible inhaled corticosteroid intraclass difference in the risk of pneumonia in COPD. Int J Chron Obstruct Pulmon Dis 2017;12:3055-64. https://doi.org/10.2147/COPD.S143656