Effect of glucocorticoids on the development of COVID-19-associated pulmonary aspergillosis: a meta-analysis of 21 studies and 5174 patients (preprint)

Objective: COVID-19-associated pulmonary aspergillosis (CAPA) remains a high mortality mycotic infection throughout the pandemic, and glucocorticoids (GCs) may be its root cause. We aimed to evaluate the effect of systemic GC treatment on the development of CAPA. Methods: We systematically searched the PubMed, Google Scholar, Scopus, and Embase databases to collect eligible studies published until December 31, 2022. The pooled outcome of CAPA development was calculated as the log odds ratio (LOR) with 95% confidence intervals (CI) using a random effect model. Results: A total of 21 studies with 5174 patients were included. Of these, 20 studies with 4675 patients consisting of 2565 treated with GC but without other immunomodulators (GC group) and 2110 treated without GC and other immunomodulators (controls) were analyzed. The pooled LOR of CAPA development was higher for the GC group than for the control group (0.54; 95% CI: 0.22, 0.86; p<0.01). In the subgroups, the pooled LOR was higher for high-dose GC (0.90; 95% CI: 0.17, 1.62: p=0.01) and dexamethasone (0.71; 95% CI: 0.35, 1.07; p<0.01)-treated patients, but there was no significant difference for low-dose GC (0.41; 95% CI: -0.07, 0.89; p=0.09)- and non-dexamethasone GC (0.21; 95% CI: -0.36, 0.79; p=0.47)-treated patients versus controls. Conclusion: GC treatment increased the risk of CAPA development, and the risk was associated with the use of high-dose GC or dexamethasone therapy.

Post-COVID-19 respiratory management: expert panel report

This report is the first expert panel report on the management of post-COVID-19 patients from India. The report contains high risk groups, post-COVID-19 patient management at primary care level, general principles of medical management of post-COVID-19 in primary care settings, management of post-COVID-19 symptoms in primary care settings, recommendations for inclusion and exclusion into the Pulmonary Rehabilitation Programme, post-COVID-19 patient management at tertiary care level, post-COVID-19 complete assessment and management, and respiratory disease-specific conditions requiring expert opinion and further research.