Table 2 Summary of findings and implications in synthesized articles

1.

Aghdam et al 2020 [18]

In this case report of a 7-year-old boy who presented with 2 years history of allergic asthma, exposure to inhaled corticosteroids based on this history was reported but duration not specified.

During his 8 day hospitalization for COVID-19, there was administration of fluticasone sprays along with intravenous hydrocortisone for at least 6 days.

Discharged and well. Initially, patient responded poorly to treatment until foreign body aspiration was identified.

Other underlying hidden causes other than COVID-19 must not be neglected in patients with concurrent COVID-19 and allergic respiratory conditions like allergic asthma

2.

Barroso et al 2020 [24]

In this case series, LABA, SABA and ICS were administered to 11 asthmatic patients out of whom 6 had allergic asthma.

For all 11 asthmatic patients, six had intermittent-asthma using short-acting-ß2-agonist and five with moderate-asthma on treatment with long-acting-ß2-agonist combined with inhaled glucocorticoid (LABA/GCI). Two of them with low-dose-LABA/GCI (one had prednisone 5mg/daily for rheumatoid arthritis) and the other three with medium-dose LABA/GCI (one had Antileukotrienes montelukast 10 mg/daily)

Only one from the five patients with moderate-asthma had good compliance with treatment.

Ten from the eleven had well controlled asthma, and one had partially controlled asthma (medium-dose-LABA/GCI and montelukast).

Two (2) patients had an asthma exacerbation on admission for COVID-19. One of them died in ICU due to complication of orotracheal-intubation, a woman of 70 years with allergic moderate-asthma on treatment with medium-dose-LABA/GCI and montelukast, with bad compliance of inhaled treatment and other comorbidities (severe sleep-apnea-hypopnea-syndrome, obesity); she was treated with LABA-GCI and systemic GC during hospitalization.

The second patient with asthma exacerbation was a woman of 42 years with allergic moderate-asthma and obesity, active smoker, type 2 diabetes, and bad compliance with inhalation therapy; she received inhaled LABA-GCI during hospitalization but not systemic GC.

The authors are of the opinion that the prognostic outcome earlier described can be attributed to underlying comorbid conditions these cases had.

They recommended for these findings to be confirmed by cohort studies with larger sample size of respiratory allergic patients with COVID-19.

3.

Barsoum 2020 [19]

In this case report of a 12-year-old girl with history of asthma but phenotype not reported, oral corticosteroids was administered the first day she came to the accident and emergency department and later discontinued the next day once the diagnosis of COVID-19 was confirmed.

Case improved and was discharged after 2 days.

Underlying comorbidity such as asthma may increase risk of susceptibility to COVID-19. This is because the oral corticosteroids used to management of asthma prolonged the duration of COVID-19 clearance.

The authors therefore recommend that clinical presentations of COVID-19 in children be critically reviewed to improve treatment outcomes.

4.

Bhatraju et al., 2020 [25]

In this case series of 24 critically ill cases, the 3 asthmatic cases received as an outpatient, systemic glucocorticoids for a presumed asthma exacerbation before becoming critically ill.

These 3 patients then presented to the hospital again, with severe respiratory failure requiring invasive mechanical ventilation.

The implications of this are uncertain and they recommend further research is necessary to determine the role of systemic glucocorticoids in patients with COVID-19 infection.

5.

Grandbastien et al., 2020 [35]

12 patients

were not received any inhaled corticosteroid, and 11 patients were received inhaled corticosteroids combined with bronchodialators (only 1 patient was treated with biotherapy and oral corticosteroids).

Among patients with asthma, 14 patients were well controlled, 6 patients were partially controlled, and 2 patients were noncontrolled.

This suggests that the risk factors for hospitalization in their patients were related more to the risk factors of SARS-CoV-2 pneumonia (e.g., hypertension, obesity, diabetes, tobacco smoke, and obstructive sleep apnea) than to asthma. SARS-CoV-2 pneumonia did not induce the severe asthma symptoms. pollen allergy appeared not to be the reason for asthma exacerbation in our patients.

6.

Desir et al., 2020 [45]

Systemic corticosteroids 44 (27%)

Hospitalized COVID-19 patients with asthma were more frequently treated with systemic steroids compared with those without asthma (27% vs 17%; P < .01).

The implications of this are uncertain at this time and may have favorably or adversely affected outcomes in these patients.

7.

Chhiba et al., 2020 [44]

Outpatient N=105

No ICS 57.1%

ICS 14.3%

ICS/LABA 28.6%

Inpatient - no ICU N=96

No ICS 50%

ICS 9.4%

ICS/LABA 40.6%

Inpatient - ICU N=19

No ICS 31.6%

ICS 10.5%

ICS/LABA 57.9%

Only 15 patients were prescribed systemic corticosteroids before diagnosis

Outpatient (N= 7), inpatient - no ICU (N= 8)

Inpatient - ICU (N= 0).

Only 1 patient was receiving an asthma-related biologic (omalizumab). This patient required an ICU stay and was intubated for COVID-19 but was successfully discharged after 16 days of hospitalization.

Systemic corticosteroid use before COVID-19 diagnosis was not different between the outpatient and inpatient managed subgroups

The use of ICS did not increase or decrease the risk of COVID-19 hospitalization in patients with asthma and COVID-19 (RR, 1.47; 95% CI, 0.93–2.32).

COVID-19-associated level of care (ICU vs non-ICU) was not significantly different between patients prescribed ICS or ICS/LABA and those not on ICS or ICS/LABA.

Similarly, the use of inhaled corticosteroids with or without systemic corticosteroids was not associated with COVID-19-related hospitalization.