Steroid nasal sprays reduce COVID-related poor outcomes, study suggests

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Regular use of steroid nasal sprays afforded COVID-19 patients protection against virus-related hospitalization, ICU admission and death, the Cleveland Clinic announced Tuesday. However, the findings don't suggest the sprays as a COVID-19 treatment and further findings are needed to confirm the results, the health system said.

The study, funded by the National Institutes of Health and published in the Journal of Allergy and Clinical Immunology, stemmed from over 70,000 COVID-19 patients ages 18 and older at the Cleveland Clinic health system from April 2020 to March 2021. Of the group, 17.5% were hospitalized, 4.1% were admitted to the ICU and 2.6% died at the hospital. Just over 14% of patients were taking a steroid nasal spray, also known as intranasal corticosteroids (INCS), before infection.

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Researchers excluded patients who received INCS prescriptions prior to 2018, as well as pregnant women, those with missing hospitalization data and others.

Patients receiving the spray before COVID-19 illness faced a 22% lower likelihood of virus-related hospitalization, 23% lower odds of ICU admission and 24% reduced risk of COVID-related hospital death, versus patients not taking a steroid nasal spray, according to a release from the Cleveland Clinic. 

"While the findings of the study encourage patients who use intranasal corticosteroids chronically to continue to do so as needed, it does not suggest that intranasal corticosteroids should be used to treat or prevent COVID-19 in any way," the release reads. "The theory behind the study, which was based on reports that intranasal corticosteroid in vitro (in the laboratory) decreased the protein receptor ACE2, allowing the SARS-CoV-2 virus that causes COVID-19 to enter cells and, spread the disease."

Steroid nasal sprays are meant to relieve irritation, allergies and stuffy nose and can be prescribed or bought over the counter.

"This study shows the importance of the nose in COVID-19 infection," Dr. Joe Zein, pulmonologist at the Cleveland Clinic, said in a statement. "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."  

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Dr. Ronald Strauss, allergist-immunologist and director of the Cleveland Allergy and Asthma Center, 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."

The health system noted future studies are needed to confirm the findings, and study authors specifically called for randomized control trials to determine whether steroid nasal sprays cut the risk of severe COVID-related outcomes.