The Latest in Critical Care, 9/28/23 (Issue #15)
Do inhaled steroids improve Covid pneumonia?
Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do they?
In the STOIC trial (a phase 2, open-label, randomized trial), 146 outpatients in the U.K. with Covid-19 randomized to 800 μg of inhaled budesonide twice daily had significantly fewer urgent care visits, and faster resolution of symptoms. Predominant SARS-CoV-2 strains during that trial’s enrollment (July-December 2020) were Wuhan, Alpha and Delta.
The PRINCIPLE trial tested 800 μg of open-label inhaled budesonide twice daily for 14 days in older, at-risk outpatients with mild Covid (aged 65 or older, or 50+ with comorbidities). Enrollment was April-November 2020, during the Wuhan strain era. Those receiving budesonide reported feeling better three days sooner than patients in the usual-care arm. There was a strong trend to…
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