Treating asthma in the COVID-19 pandemic

[...]ciclesonide has been found to suppress the replication of SARS-CoV-2 through interaction with viral NSP15 during biogenesis, and fluticasone propionate has been identified as a potential therapeutic candidate in COVID-19.14 15 The use of ICS in asthma has been associated with decreased expression of ACE2 and transmembrane protease serine 2 in sputum, suggesting ICS may reduce viral attachment and cell entry through these pathways.7 Although preliminary, these data reinforce the view that the benefits of ICS treatment in asthma are likely to outweigh any potential risks. There is little evidence for the direct effects of other asthma medications in COVID-19, and the use of systemic corticosteroids has been controversial.16 Although the recent use of oral corticosteroids in asthma was associated with a higher risk of in-hospital COVID-19-related death than those who did not, this association may be reflective of poor disease control rather than the medication itself.6 Therefore, optimising asthma control, via optimising medication adherence, minimising the need for systemic steroids, avoidance of hospitalisation and hence (nosocomial) SARS-CoV-2 exposure, appears to be important in the protection against COVID-19. Eosinophils have been implicated in antiviral immunity in preclinical studies, and eosinopaenia has been reported in over half of patients with COVID-19 and linked to poor prognosis.2 18 In patients with mild asthma challenged with RV, mepolizumab did not affect clinical outcome, but a significant increase in viral shedding was observed.19 The implications during the pandemic are unknown but whether accelerated efforts should be made in initiating appropriate biologics in the hope of reducing maintenance systemic glucocorticoids in severe asthmatics should be considered. To date, there are no consistent data to suggest that well-controlled asthma is over-represented in COVID-19. [...]the objective of asthma management during the pandemic is centred on optimising asthma control and minimising risks of viral exposure.