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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 48-year-old man developed COVID-19 infection during treatment with salmeterol/fluticasone propionate for asthma. Additionally, he experienced delayed clearance coronavirus 2 (SARS CoV 2) RNA during treatment with salmeterol/fluticasone, budesonide and methylprednisolone for asthma [time to reactions onsets not stated; not all routes and dosages stated].
The man was admitted on 24 January 2020 with a 4-day history of fever. He had a history of short stay in Wuhan, China. He also had asthma for 10 years, which was being treated with inhaled salmeterol/fluticasone-propionate [salmeterol/fluticasone] at a dose of 50/250 µg twice daily.
He was admitted. He developed cough and low-grade fever. A CT scan revealed increased ground-glass opacities in the bilateral superior lobe. His nasopharyngeal swab was collected. A reverse transcriptase PCR (RT-PCR) was positive for SARS-CoV-2 RNA. He was diagnosed with mild COVID-19 infection secondary to the glucocorticoid therapy.
The man received off-label treatment with oseltamivir, interferon α 2b and lopinavir/ritonavir from 25 to 28 January 2020. He experienced chest tightness due to an asthma attack. On 25 January 2020, he started treatment with atomisation budesonide and terbutaline. On 28 January 2020, he started receiving methylprednisolone, to prevent asthma exacerbation. On 31 January 2020, he showed improvement in the respiratory symptoms. On 1 February 2020, he developed paroxysmal cough and wheeze, and was treated with terbutaline and budesonide to reduce the airway hyper-responsiveness. On 10 February 2020, he showed complete recovery. He continued receiving inhaled salmeterol/fluticason propionate. His subsequent nasopharyngeal swab was negative for SARS-CoV-2 RNA; however, his sputum sample was positive for SARS-CoV-2 RNA. In the subsequent sputum samples obtained on 16, 19 and 22 February 2020, the SARS-CoV-2 RNA was found to be positive. On 1 March 2020, SARS-CoV-2 RNA was not detected in sputum samples as well as in nasopharyngeal swab. It was concluded that glucocorticoids inhibited the immune function and played a critical role in delayed clearance of SARS-CoV-2 RNA despite resolution of symptoms.
Reference
- Ma S-Q, et al. Glucocorticoid therapy delays the clearance of SARS-CoV-2 RNA in an asymptomatic COVID-19 patient. Journal of Medical Virology 92: 2396-2397, No. 11, 29 May 2020. Available from: URL: 10.1002/jmv.26086 [DOI] [PMC free article] [PubMed]