Two recent large studies in the UK have shown that inhaled budesonide, given early during Covid infection, reduced the time that people had symptoms and also prevented clinical worsening that required hospitalisation.
Budesonide, a commonly used asthma drug, was used as a treatment shortly after people developed symptoms consistent with Covid-19, with a proportion of people confirmed on PCR testing to have acute infection.
However, a separate trial used a different inhaled corticosteroid, ciclosenide, did not demonstrate a significant benefit.
National Asthma Council Australia Director and respiratory physician Professor Peter Wark says that in Australia it was still too early to recommend regular prescription of inhaled budesonide with Covid-19.
“At this stage The Australian guidelines for the clinical care of people with Covid-19 do not recommend the use of inhaled corticosteroids including budesonide outside of a clinical trial.
“However, the two clinical trials that showed the introduction of budesonide treatment early in the illness before people became unwell in primary care settings was extremely promising, well tolerated and not associated with any significant side effects of concern,” he says.
The mechanism of action of just how the inhaled budesonide works at the site where SARS-CoV-2 is likely to be causing its biggest effect is still unknown.
“It has been proposed that inhaled corticosteroids may reduce expression of the receptor that the virus uses in order to get into our cells and cause infection. This may then limit the spread of infection to the lungs,” adds Professor Wark.
Professor Wark is now part of a team from the Centre for Healthy Lungs HMRI, University of Newcastle, and the University of Sydney Clinical trials centre and RPA virtual Sydney that have just received funding from NSW health for a trial of inhaled ciclosenide for people in NSW to prevent more severe Covid-19 disease and its effect on the spread of infection.
“Our aim will be to assess efficacy of inhaled ciclesonide in reducing the need for urgent medical care due to infection in those people who are in hotel or home quarantine with mild Covid-19 disease.
“We hope to see if this leads to a faster resolution of symptoms and whether people clear the virus more quickly with treatment,” he says.
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