COVID-19 or SARS-CoV-2 was declared a pandemic by the world health organisation in 2020. It has rocked the whole world, resulting in a staggering number of deaths. There are endless clinical trials to produce a vaccine that will give people immunity, but we are still in the very early stages. COVID-19 has brought the world to a halt, stopping school and universities and having a massive impact on the economy. Medical specialists and researchers have not found an asthma medication that shows potential as a treatment against this aggressive virus. There has been debate on the potential of Fluticasone as a potential treatment of COVID-19 and multiple research articles have been published trying to prove its efficacy as a treatment.
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COVID-19 is a strain of coronavirus that affects the lungs and airways. The main symptoms of COVID-19 are:
- High temperature - feeling hot to touch on your chest and back
- New persistent cough - coughing continuously for an hour or 3+ coughing fits in a 24 hour period
- Loss/change of taste and smell - losing your sense of smell and taste or nothing things smell and taste differently to normal
The one established way to prevent the spread of COVID-19 is to prevent contact with people who have COVID-19 symptoms. Always ensure you wash your hands for more than 20 seconds, maintain a social distance from others and keep a mask on in crowded places. And make sure you follow the government guidelines established for your area.
Fluticasone is a drug which belongs to a group of medications called corticosteroids. It can be taken orally (inhaled), nasally or used as a topical cream. Depending on the diagnosis, the doctor will prescribe a different route for the medication. Fluticasone is FDA approved for the treatment of asthma, but can also be used to improve lung function in patients suffering from COPD. The nasal spray is used to treat allergic and non-allergic rhinitis, nasal polyps and allergies. Fluticasone cream is used for the treatment of atopic dermatitis, like eczema.
The drug Fluticasone has vasoconstrictor and anti-inflammatory properties. That means that it narrows blood vessels and decreases the levels of certain inflammatory cells. Fluticasone not only decreases the number of these cells, but also the number of cytokines they produce. Cytokines are chemicals involved in cell signalling in the immune system. They signal for immune cells to migrate to areas of inflammation.
Normally, cytokines are useful to the body and they help it fight off infection, but sometimes things can go wrong. Excessive levels of cytokines - often called a ‘cytokine storm’ - can lead to aggressive inflammation, which can cause damage to a number of tissues in the body.
COVID-19 causes this aggressive inflammatory response in infected individuals, leading to a cytokine storm and an excessive inflammatory reaction. Given that this leads to tissue damage, studies have proposed that this may be responsible for the lung injury, multi-organ failure and poor prognosis found in patients with severe COVID-19.
Can Fluticasone help?
You would think since Fluticasone reduces cytokine release and inflammatory cells, which are increased in COVID-19 infection, it would be an ideal treatment option. Sadly, medicine is not that clear cut. Doctors and patients have to weigh up the benefits and risks of treatment before they prescribe it and to date, there have not been enough studies looking into the real effects that Fluticasone has on COVID-19.
Several other corticosteroids have been used to treat patients with COVID-19 at the doctor’s discretion. Unfortunately, Budesonide - another corticosteroid - was found to have no effect on cytokine production and viral replication in COVID-19. So more research is needed before we find out what works.
As medicine and COVID-19 is a rapidly changing field, there is new research taking place every day and new uses for current medications are being explored constantly. Currently, there is no certain link found between the use of Fluticasone against COVID-19, however, we hope a new discovery will be made soon to help put an end to this pandemic. At the moment, all we can do is practise social distancing, hand hygiene to try to prevent the spread of this potent virus.
- Lipworth B, Chan R, Kuo CR. Use of inhaled corticosteroids in asthma and coronavirus disease 2019. Annals of Allergy, Asthma & Immunology. [Online] 2020; Available from: doi:10.1016/j.anai.2020.06.026 [Accessed: 23rd September 2020]
- CEBM. Inhaled corticosteroids: A rapid review of the evidence for treatment or prevention of COVID-19. [Online] CEBM. Available from: https://www.cebm.net/covid-19/inhaled-corticosteroids-a-rapid-review-of-the-evidence-for-treatment-or-prevention-of-covid-19/ [Accessed: 23rd September 2020]
- NHS. Fluticasone nasal spray and drops - Medicine. [Online] nhs.uk. Available from: https://www.nhs.uk/medicines/Fluticasone-nasal-spray-and-drops/
- Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 Cytokine Storm; What We Know So Far. Frontiers in Immunology. [Online] 2020;11. Available from: doi:10.3389/fimmu.2020.01446
- Remien K, Bowman A. Fluticasone. [Online] PubMed. Treasure Island (FL): StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK542161/