Table 1.

Recommendation on the use of inhaled and oral corticosteroids by major respiratory and health societies.

Society	Recommendation	Reference
Global Initiative for Asthma (GINA)	‘People with asthma should continue all of their inhaled medication, including inhaled corticosteroids, as prescribed by their doctor.’ ‘In acute asthma attacks, patients should take a short course of oral corticosteroids if instructed in their asthma action plan or by their healthcare provider, to prevent serious consequences.’ ‘In rare cases, patients with severe asthma might require long-term treatment with oral corticosteroids (OCS) on top of their inhaled medication(s). This treatment should be continued in the lowest possible dose in these patients at risk of severe attacks/exacerbations.’	[38]
Global Initiative for Obstructive Lung Disease (GOLD)	‘GOLD is not aware of any scientific evidence to support that inhaled (or oral) corticosteroids should be avoided in patients with COPD during the COVID-19 epidemic.’ ‘COPD patients should maintain their regular therapy.’	[39]
European Lung Foundation	‘Patients with asthma should never stop taking their preventer inhaler unless asked to do so by a medical professional. Stopping your steroid inhaler could put you at higher risk of complications with COVID-19 due to making your asthma worse.’	[40]
American Lung Association	‘If you use inhaled corticosteroids or intranasal steroids, there’s probably not a risk to developing a weakened immune system. If you use oral corticosteroids, there’s a slight increase of a suppressed immune system. If you’re in an asthma flare, your healthcare provider can help you decide which medications are the right choice to help you breathe. Do not stop or avoid taking your medication without discussing it with your healthcare provider.’	[41]
British Thoracic Society	‘There is no evidence that inhaled steroids increase the risk of getting COVID-19 so please advise your patients to continue with all of their inhalers, including ICS and ICS/LABA combination inhalers.’ ‘If your patient develops symptoms and signs of an asthma exacerbation then they should follow their personalised asthma action plan and start a course of steroids if clinically indicated.’ ‘For patients on maintenance oral corticosteroids, they should continue to take them at their prescribed dose as stopping steroids suddenly can be harmful. It is worth reiterating the “sick day rules” and reminding patients that if they become unwell (for any other reason) they need to increase their steroid dose appropriately (usually doubled).’	[42]
The Primary Care Respiratory Society	‘People with asthma must continue their preventive ICS according to current guidelines.’ ‘Oral corticosteroids should be used in people with asthma attacks according to current UK guidelines. There is no evidence to suggest appropriate use of OCS in asthma attacks will cause a worse outcome if COVID 19 or similar viruses are suspected to be the trigger.’	[43]
Asthma and Allergy Foundation of America	‘Steroids are not a risk for people with asthma, so continue to take your medications as prescribed.’	[44]
National Institute for Health and Care Excellence (NICE)	‘Recommends that patients should continue taking their regular inhaled and oral medicines, including corticosteroids, in line with their individualized self-management plan. This includes those with COVID-19 or suspected of having it.’ ‘If they develop symptoms of COVID-19, the guidance advises that patients should not start a short course of oral corticosteroids and/ or antibiotics.’ ‘Patients using non-invasive ventilation at home should be advised that, because these are potentially infectious aerosol-generating procedures, they should take appropriate precautions such as using equipment in a well-ventilated room and using it way from other family members if possible.’	[45]