Asthma drug accelerates coronavirus recovery in patients

An asthma drug has shown promise among coronavirus patients who are ill with the infection at home.

Early research suggests the coronavirus is mild in four out of five cases, however, it can trigger a disease called Covid-19.

Patients with severe complications like dangerously low oxygen levels, unconsciousness or even sepsis are admitted to intensive care, where they are often treated with the steroid dexamethasone.

Less serious cases are advised to recover at home with rest, drinking plenty of fluids and taking paracetamol or ibuprofen to ease any fever.

With at-home patients still often feeling severely unwell, scientists from the University of Oxford found inhaling the asthma drug budesonide twice a day for two weeks speeds up an individual's self-reported recovery by 72 hours.

Budesonide is an inhaled corticosteroid, which are known to ease inflammation; a key driver of ill health with Covid-19.

Laboratory studies suggest budesonide also reduces the coronavirus' replication and expression of cells' Ace2 receptor, which the infection uses to invade the body.

The results are preliminary and have not yet been published in a peer-reviewed journal.

"You can be pretty damn sick with this thing even if you don't require oxygen," said co-lead investigator Professor Chris Butler. "People will [generally] only be admitted to hospital if their oxygen is running low.

"You won't be admitted for a trivial reason and you can be really really sick with this [virus] at home."

Professor Butler, who has overcome the coronavirus himself, added: "If someone could have taken three days off my illness duration, I would have been extremely grateful."

This arm of the so-called Principle trial was initiated after it was observed relatively few asthma and chronic obstructive pulmonary disease patients were treated in hospital with the coronavirus, with inhaled corticosteroids potentially being protective.

To learn more, the Oxford scientists analysed more than 1,700 participants who tested positive for the coronavirus.

The participants were either otherwise healthy and aged 65 or over, or in their fifties or older with underlying medical conditions.

Coronavirus complications are more common in older people and those with pre-existing health issues.

All the study's participants had been unwell for at least 14 days. They were given either "usual care", defined as largely "supportive" therapies like paracetamol, or usual care plus 800 micrograms of budesonide twice a day.

There was no placebo comparison, which is considered the gold standard of research.

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Results reveal the time to "self reported recovery" was three days shorter in those on budesonide.

This was true regardless of the participant's age, symptom severity or duration, or underlying health.

"Three days shorter [ill health] certainly sounds worthwhile to me," said Professor Kevin McConway from The Open University, who was not involved in the study.

Just under a third (32%) of those on budesonide recovered within 14 days, versus around one in five (22%) in the usual care group.

They also "subsequently remained well until 28 days" and reported "greater wellbeing after two weeks".

Among the 92% of the participants "who had the opportunity to contribute data for 28 days follow up", 8.5% in the budesonide group were hospitalised or died with the coronavirus, versus 10.3% of those just on usual care.

"Since fewer than expected people were admitted to hospital in the trial, and with Covid-19 cases and hospitalisations continuing to drop in the UK, it is not clear from this interim analysis whether budesonide reduces hospitalisations," wrote the scientists.

More data will be revealed once the 28 day follow up analysis is completed for all the participants.

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The scientists believe their results could change how the coronavirus is treated in the early stages of ill health at home.

According to co-trial investigator Dr Gail Hayward, a suitable drug "needs to be a relatively cheap treatment, easy to use, have few side effects and wide availability".

"Budesonide has all these characteristics," she added.

When asked about the drug's price, Dr Hayward said: "Working out the treatment cost is complicated because it involves the overall picture. The cost of the inhaler itself is about £14 [$19.27]."

Professor Butler added: "We anticipate medical practitioners around the world caring for people with Covid-19 in the community may wish to consider this evidence when making treatment decisions, as it should help people with Covid-19 recover quicker."

It is unclear if the UK's health watchdog the National Institute for Health and Care Excellence (Nice) will recommend inhaled budesonide on the NHS.

Principle was launched in April 2020 with "the intention drugs shown by the trial to have a clinical benefit could be rapidly introduced into routine NHS primary care".

The ongoing trial is evaluating a range of potential at-home treatments to reduce a coronavirus patient's recovery time, while preventing hospital admissions and deaths.

In January 2021, the Principle scientists found the antibiotics azithromycin and doxycycline "are not effective treatments for Covid-19 in the early stages of the illness, changing clinical practice in the UK and internationally".

"Unlike other proven treatments, budesonide is effective as a treatment at home and during the early stages of the illness," said co-trial investigator Professor Richard Hobbs.

"This is a significant milestone for this pandemic and a major achievement for community-based research."