Steroid nasal sprays may help improve outcomes in severe COVID-19 disease

Sept. 29, 2021

A recent Cleveland Clinic study found that patients who regularly use steroid nasal sprays are less likely to develop severe COVID-19-related disease, including a 20 to 25% lower risk of hospitalization, ICU admission and mortality. The study was published in Journal of Allergy and Clinical Immunology: In Practice, and in a Cleveland Clinic press release.

Joe Zein, M.D, Ph.D., a pulmonologist at Cleveland Clinic and Ronald A. Strauss, M.D., an allergist-immunologist and Director of the Cleveland Allergy and Asthma Center, and colleagues at Cleveland Clinic followed 72,147 COVID-19 positive individuals, ages 18 years and older, within the Cleveland Clinic health system from April 1, 2020, to March 31, 2021. Of that cohort, 12,608 (17.5%) were hospitalized, 2,935 (4.1%) were admitted to ICU and 1,880 (2.6%) died during hospitalization. Within this group, 10,187 (14.1%) patients were receiving a steroid nasal spray – also known as intranasal corticosteroids – prior to COVID-19 infection.

Patients who used intranasal corticosteroids prior to COVID-19 illness were 22% less likely to be hospitalized, 23% less likely to be admitted to the intensive care unit, and 24% less likely to die from COVID-19 during hospitalization compared to patients not on intranasal corticosteroids.

While the findings of the study encourage patients who use intranasal corticosteroids chronically to continue to do so as needed, it does not suggest that intranasal corticosteroids should be used to treat or prevent COVID-19 in any way. The theory behind the study, which was based on reports that intranasal corticosteroid in vitro (in the laboratory) decreased the protein receptor ACE2, allowing the SARS-CoV-2 virus that causes COVID-19 to enter cells and, spread the disease.

Cleveland Clinic release

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