Inhaled
corticosteroids are known to be relatively safe for long-term use in inflammatory
respiratory diseases and it has been repurposed as one of the potential
therapies for outpatients with
coronavirus disease 2019 (COVID-19). However, inhaled
corticosteroids have not been accepted for
COVID-19 as a standard
therapy because of its lack of proven benefits. Therefore, this study aimed to evaluate the effectiveness of inhaled
corticosteroids in patients with
COVID-19. Randomized controlled trials comparing the efficacy of inhaled
corticosteroid treatment in patients with
COVID-19 were identified through literature electronic database searches up to March 10, 2023. Meta-analyses were conducted for predefined outcomes, and the certainty of evidence was graded using the grading of recommendations, assessment, development, and evaluation approach. Overall, seven trials (eight articles) were included in this systematic review. Compared with usual care, inhaled
corticosteroids was associated with significantly improved clinical recovery at 7 and 14 days in patients with
COVID-19. In subgroup analysis, only
budesonide showed significant efficacy in clinical recovery, whereas no significant benefit was observed for
ciclesonide. Moreover, inhaled
corticosteroids use was not significantly associated with all-cause hospitalization, all-cause mortality, admission to intensive care unit, or the use of
mechanical ventilation. Our systematic review used evidence with very low to moderate certainty. Although based on limited evidence, our results suggest that inhaled
corticosteroids treatment, especially
budesonide, improves the clinical recovery of patients with
COVID-19. More trials and meta-analyses are needed to assess the efficacy of inhaled
corticosteroids for
COVID-19 treatment.