Association between inhaled corticosteroid use and SARS-CoV-2 infection: A nationwide population-based study in South Korea

Abstract

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 infectionamong 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 inKorea. The positivity of SARS-CoV-2 infection was retrospectively analysed according to the prescription, type, and doseof 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 prescribedin 7.5%, 1.6%, and 6.5% of total cases, respectively. Among types of ICS, budesonide, fluticasone, beclomethasone, andciclesonide were prescribed in 3.7%, 8.9%, 2.3%, and 0.6% of total cases, respectively. A multivariate analysis showed nosignificant increase in infection with ICS use (odds ratio, 0.84; 95% confidence interval, 0.66–1.03). Moreover, there wereno 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 ofICS did not affect this positivity.