Previous study reported that preadmission insulin treatment in patients with coronavirus disease 2019 (COVID-19) and concurrent diabetes was associated with a significantly increased odds of mortality. However, such association may be modified by possible baseline differences in glycemic control between insulin users and non-insulin users. Misinterpretation of the association between insulin treatment and mortality could lead to confusion in clinical practice and hospitalized patients with COVID-19 for whom insulin treatment is appropriately indicated may be omitted from such treatment. However, requirement for insulin during hospitalization for COVID-19 may be a marker of poor prognosis and as such could be used to identify patient population who require more aggressive treatments to prevent mortality.
Objective: With emerging of observational evidence, we aimed to perform a meta-analysis to summarize the overall effect of the chronic use of inhaled corticosteroids on the clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Methods:Systematic literature search in electronic databases was performed to identify observational studies that investigated the preadmission use of inhaled corticosteroids on the risk of a fatal or severe course of illness in patients with COVID-19 and reported adjusted measures of association. Adjusted odds ratios or relative risks and the corresponding 95% confidence intervals from each study were pooled to produce pooled odds ratio and 95% confidence interval. Results: The meta-analysis revealed no significant difference in the risk for the development of a fatal course of COVID-19 with preadmission use of inhaled corticosteroids in patients with COVID-19 relative to non-use of inhaled corticosteroids (pooled odds ratio=1.28; 95% confidence interval 0.73-2.26). Similarly, the meta-analysis observed no significant difference in the risk for the development of a severe course of COVID-19 with preadmission use of inhaled corticosteroids in patients with COVID-19 relative to non-use of inhaled corticosteroids (pooled odds ratio=1.45; 95% confidence interval 0.96-2.20).Conclusions: Our findings assured the safety of continued use of inhaled corticosteroids during the COVID-19 pandemic.