Budesonide and COVID-19
A patient asked about Budesonide by nebulization to treat COVID-19. Is there information about this, or is it all anecdotal?
Currently available information is primarily anecdotal. I asked the AAAAI COVID-19 Response Task Force to weigh in and received the following response from Dr. Mitch Grayson:
"There has been a study from the Severe Asthma Research Program (SARP) investigators demonstrating reduced ACE2 and TMPRSS2 mRNA expression in sputum from severe asthmatics on ICS (with a modest dose response) (Am J Respir Crit Care Med. 2020 Jul 1; 202(1): 83-90.). Caution is that this study depends on mRNA and not protein expression, and has not been repeated. A review of the literature done before the SARP study was published found no compelling data for or against the use of ICS in COVID-19 (Eur Respir J. 2020 May; 55(5): 2001009.). So this is not necessarily anecdotal (although the use of nebulization would be), but there is no clear data to support the use of budesonide to treat COVID-19. There are several clinical trials ongoing looking at the use of inhaled budesonide with or without LABA (with or without additional therapies) in COVID-19 (NCT04416399, NCT04331470, NCT04355637, NCT04331054, and NCT04193878), so, hopefully, we will soon know the outcome of ICS therapy as a treatment for COVID-19."
As you can see, there are ongoing clinical trials to address this issue. Furthermore, caution must be taken when considering nebulization for an individual actively infected with SARS-CoV-2.
I hope this is helpful.
Daniel J. Jackson, MD, FAAAAI