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.

Findings from the study were published in the Journal of Allergy and Clinical Immunology: In Practice. Joe Zein, MD, PhD, a pulmonologist at Cleveland Clinic, and Ronald A. Strauss, MD, an allergist-immunologist and director of the Cleveland Allergy and Asthma Center, and colleagues at Cleveland Clinic used the Cleveland Clinic COVID-19 Research Registry to conduct propensity-score matching for treatment with intranasal corticosteroids (INCS) before SARS-CoV-2 infection (April 1, 2020, to March 31, 2021). Of the 82,096 individuals who tested positive, 72,147 met inclusion criteria. The study endpoints included the need for hospitalization, admission to the ICU, or in-hospital mortality.

The researchers discovered that of the 12,608 (17.5%) patients who were hospitalized, 2,935 (4.1%) required ICU admission and 1,880 (2.6%) died during hospitalization. A significant proportion (n = 10,187; 14.1%) were using INCS before SARS-CoV-2 infection. Compared with nonusers, INCS users demonstrated lower risk for hospitalization (adjusted odds ratio [OR] [95% confidence interval (CI)]: 0.78 [0.72; 0.85]), ICU admission (adjusted OR [95% CI]: 0.77 [0.65; 0.92]), and in-hospital mortality (adjusted OR [95% CI]: 0.76 [0.61; 0.94]).

These findings were replicated in sensitivity analyses that excluded patients on INCS and those with allergic rhinitis. The beneficial effect of INCS was significant after adjustment for baseline blood eosinophil count (measured before SARS-CoV-2 testing) in a subset of 30,289 patients. The researchers concluded that INCS therapy is linked to a lower risk for COVID-19Ðrelated hospitalization, ICU admission, or death, and that future randomized, controlled trials (RCTs) are needed to determine if INCS reduce the risk for severe outcomes related to COVID-19.

The researchers also indicated that while the findings of the study encourage patients who use INCS chronically to continue to do so as needed, they do not indicate that INCS should be used to treat or prevent COVID-19 in any way. The theory behind the study was based on reports that INCS in vitro reduced the protein receptor, angiotensin-converting enzyme 2, which allows the SARS-CoV-2 virus that causes COVID-19 to enter cells and spread the disease.

The authors wrote, "Our study demonstrates that INCS usage is associated with decreased COVID-19-related hospital admission, ICU admission, and mortality. Our findings demonstrate the need for future studies including RCTs on INCS usage to corroborate our findings and determine whether INCS improves health care–related outcomes due to COVID-19."

Joe Zein, MD, PhD, a pulmonologist at Cleveland Clinic, stated, "This study shows the importance of the nose in COVID-19 infection. The nose, in this instance is the gateway to our bodies, allowing the virus to enter and replicate within. The use of intranasal corticosteroids may help disrupt that gateway."

Dr. Strauss added, "Our findings are particularly significant, as decreased COVID-19 hospitalizations, ICU admissions, and mortality could alleviate the strain on health care systems with limited resources across the globe, especially in developing countries where there is limited access to vaccines and where mutations in SARS-CoV-2 have emerged."

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