Asthma, Inhaled Corticosteroids, and Covid Vaccine Group 6

[gustavholst]

There has been considerable confusion caused by conflicting information regarding the criteria for inclusion in covid vaccine priority group 6. Whilst groups such as Asthma UK are seeking urgent clarification, for now it seems likely those taking inhaled corticosteroids (as opposed to tablets) could be excluded.

Reassuringly, several studies have shown that people with non-severe asthma are not at a significantly greater risk of hospitalisation or death. However, some have pointed to the use of ICS (inhaled corticosteroids) among asthma patients as a confounding factor:

thelancet.com/journals/lanr...

One recent study hypothesises that routine ICS use could be responsible for the under-representation of individuals with chronic respiratory disease suffering severe Covid outcomes, and goes on to demonstrate that inhaled budesonide significantly reduces the risk of severe illness and hospitalisation:

medrxiv.org/content/10.1101...

This raises important questions regarding the vulnerability of people with asthma taking ICS as compared with non-asthmatic people. Can adjustments in the vulnerability of asthma patients be made to account for the mitigating effects of ICS use with any degree of certainty? If the use of ICS to treat covid becomes commonplace, is the risk of severe illness in those with asthma who routinely take ICS to control their asthma the same as that of non-asthmatic people who are treated with ICS in the early stages of infection, or is it merely lessened to the level of non-asthmatic patients without ICS treatment?

To phrase the question another way, are people with asthma at greater risk of severe illness than those without asthma once ICS use is factored out of the equation?

Straight-forward answers to these questions may not be possible in the short term. It has not yet been proven that people with asthma taking ICS are not at greater risk of severe illness than people without asthma if those non-asthmatic covid patients are treated with ICS.

Has any of this been taken into account in deciding which asthma patients are included in JCVI priority group 6? This issue warrants urgent consideration by the JCVI. Has anyone at Asthma UK or elsewhere looked into this?

[Loulou9000]

Thank you for taking the time to review the evidence, much appreciated.

Great questions raised and look forward to hearing and seeing the responses that support the JCVI stance other than their report. I would love to see the data on which they base their conclusions.

[Ts777]

An expert, this is what we need!!