IMPACT OF INHALED CORTICOSTEROID USE ON OUTCOMES IN HOSPITALIZED PATIENTS WITH COVID-19 AND OBSTRUCTIVE LUNG DISEASES

ABSTRACT

SESSION TITLE COPD Medications and Treatment Outcomes SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/19/2022 1115 am - 1215 pm PURPOSE: Conclusive data on whether inhaled corticosteroids (ICS) have a protective effect on COVID-19 hospitalization rates or outcomes are lacking. The main objective of our study was to assess the impact of pre-hospitalization ICS use on the clinical course of hospitalized COVID-19 patients with underlying obstructive lung diseases - asthma and chronic obstructive pulmonary disease (COPD). METHODS: We conducted a retrospective chart review study of all COVID-19 patients hospitalized at our institution between March 1st - June 3th, 2020. Diagnosis of asthma and COPD was determined using ICD-10 codes. Demographics, information about pre-hospitalization ICS use and clinical data were recorded through chart review. Outcomes of interest were all-cause 28-day mortality and need for intubation. Chi-square or Fischer’s exact test was used to assess univariate associations. Linear and logistic regression models were constructed to adjust for potential confounders. RESULTS: Data was analyzed from 356 hospitalized COVID-19 patients with prior diagnosis of obstructive lung disease;219/356 (62%) had asthma, 137/356 (38%) had COPD. Hospitalized COVID-19 patients with asthma were younger (mean age 61 [range 51-71] vs 74 [range67-81] years, p<0.01), more likely to be female (69% vs 48%, p<0.01), Hispanic (43% vs 25%, p<0.01) and never smokers (52% vs 20%, p<0.01) compared to those with COPD. There was no difference in the use of pre-hospitalization ICS between the two groups (35.2% in Asthma vs 38% in COPD, p=0.59). Overall, COVID-19 patients with COPD were more likely to die compared to those with asthma (47% vs 25%, p<0.01). Pre-hospitalization ICS use was not significantly associated with all-cause 28-day mortality (asthma OR 0.9 [95%CI 0.4-2.0], p=0.85;COPD OR 0.7 [95%CI 0.3-1.5], p=0.3) or need for intubation (asthma OR 1.0 [95%CI 0.5-2.0], p=0.94;COPD OR 0.7 [95%CI 0.3-1.7],p=041) after adjusting for potential confounders. CONCLUSIONS: Mortality among hospitalized COVID-19 patients with COPD was higher compared to those with asthma. While the pre-hospitalization use of ICS was similar between the two groups, it did not protect hospitalized COVID-19 patients in either group from intubation or mortality. High mortality rates among COVID-19 patients with COPD is likely due to concomitant risk factors such as older age, and comorbidities such as diabetes and chronic kidney disease. Being a retrospective study, the quality of our data was limited and dependent on documentation accuracy. CLINICAL IMPLICATIONS Pre-hospitalization ICS use did not improve outcomes in hospitalized COVID-19 patients with asthma or COPD. Further studies are required to investigate the role of ICS in preventing COVID-19 related hospitalizations, morbidity and mortality in randomized control settings. DISCLOSURES No relevant relationships by Hammad Aleem No relevant relationships by Denisa Ferastraoaru No relevant relationships by Manuel Hache Marliere No relevant relationships by Gabriel Hernández Romero No relevant relationships by Christa McPhee No relevant relationships by Francine Palmares No relevant relationships by Divya Reddy No relevant relationships by Felix Reyes No relevant relationships by Deborah Schwartz