tetano
Editor, Senior Moderator
BMJ Open Respir Res
. 2026 Apr 1;13(1):e003800.
doi: 10.1136/bmjresp-2025-003800.
Differential association of fluticasone furoate and budesonide with clinically detected COVID-19: a retrospective cohort study
Masaki Tsunemi[SUP] 1 [/SUP], Kozo Kuribayashi[SUP] 2 [/SUP], Eiji Ishimura[SUP] 3 [/SUP], Kiyokazu Yoshinoya[SUP] 4 [/SUP], Tetsuya Hayashi[SUP] 5 [/SUP], Toru Muto[SUP] 6 [/SUP], Hiroyuki Sakamoto[SUP] 7 [/SUP], Takashi Kijima[SUP] 2 [/SUP]
Affiliations
Objectives: To assess whether fluticasone furoate (FF) use, compared with budesonide (BUD), is associated with fewer clinically detected COVID-19 events among inhaled corticosteroids (ICS) users, and to explore virus-specificity using influenza as a comparator outcome. We hypothesised that FF may provide strong local anti-inflammatory effects with limited systemic immunosuppression.
Design: Retrospective cohort with outpatient follow-up over 4 years.
Setting: Single Japanese medical centre.
Participants: 334 adults (102 ICS users; 232 non-ICS) followed from July 2020 to July 2024.
Main outcome measures: Clinically detected COVID-19 (primary) and influenza (secondary). The primary exposure comparison was FF versus BUD among ICS users; ICS versus non-ICS was analysed secondarily (exploratory). Cox proportional hazards and logistic regression are adjusted for demographics, comorbidities, vaccination and systemic corticosteroids.
Results: Seventy-nine COVID-19 and 14 influenza events occurred. Among ICS users, FF was associated with fewer clinically detected COVID-19 events than BUD (adjusted HR 0.12, 95% CI 0.02 to 0.73; crude 6.5% vs 32.3%; Fisher's exact p=0.0047). Under symptom-based testing, ICS users also had fewer clinically detected COVID-19 events than non-ICS users (adjusted HR 0.46, 95% CI 0.22 to 0.94), although this comparison is limited by baseline imbalance and should be interpreted as exploratory and non-causal.
Conclusions: Under symptom-triggered testing, FF was associated with fewer clinically detected COVID-19 events than BUD in the head-to-head comparison among ICS users. The ICS versus non-ICS comparison is exploratory due to confounding by indication and structural imbalance. These findings are hypothesis-generating and warrant prospective studies with systematic testing and stronger designs.
Keywords: Airway Epithelium; Asthma; Drug reactions; Inflammation; Viral infection.
. 2026 Apr 1;13(1):e003800.
doi: 10.1136/bmjresp-2025-003800.
Differential association of fluticasone furoate and budesonide with clinically detected COVID-19: a retrospective cohort study
Masaki Tsunemi[SUP] 1 [/SUP], Kozo Kuribayashi[SUP] 2 [/SUP], Eiji Ishimura[SUP] 3 [/SUP], Kiyokazu Yoshinoya[SUP] 4 [/SUP], Tetsuya Hayashi[SUP] 5 [/SUP], Toru Muto[SUP] 6 [/SUP], Hiroyuki Sakamoto[SUP] 7 [/SUP], Takashi Kijima[SUP] 2 [/SUP]
Affiliations
- PMID: 41922024
- DOI: 10.1136/bmjresp-2025-003800
Objectives: To assess whether fluticasone furoate (FF) use, compared with budesonide (BUD), is associated with fewer clinically detected COVID-19 events among inhaled corticosteroids (ICS) users, and to explore virus-specificity using influenza as a comparator outcome. We hypothesised that FF may provide strong local anti-inflammatory effects with limited systemic immunosuppression.
Design: Retrospective cohort with outpatient follow-up over 4 years.
Setting: Single Japanese medical centre.
Participants: 334 adults (102 ICS users; 232 non-ICS) followed from July 2020 to July 2024.
Main outcome measures: Clinically detected COVID-19 (primary) and influenza (secondary). The primary exposure comparison was FF versus BUD among ICS users; ICS versus non-ICS was analysed secondarily (exploratory). Cox proportional hazards and logistic regression are adjusted for demographics, comorbidities, vaccination and systemic corticosteroids.
Results: Seventy-nine COVID-19 and 14 influenza events occurred. Among ICS users, FF was associated with fewer clinically detected COVID-19 events than BUD (adjusted HR 0.12, 95% CI 0.02 to 0.73; crude 6.5% vs 32.3%; Fisher's exact p=0.0047). Under symptom-based testing, ICS users also had fewer clinically detected COVID-19 events than non-ICS users (adjusted HR 0.46, 95% CI 0.22 to 0.94), although this comparison is limited by baseline imbalance and should be interpreted as exploratory and non-causal.
Conclusions: Under symptom-triggered testing, FF was associated with fewer clinically detected COVID-19 events than BUD in the head-to-head comparison among ICS users. The ICS versus non-ICS comparison is exploratory due to confounding by indication and structural imbalance. These findings are hypothesis-generating and warrant prospective studies with systematic testing and stronger designs.
Keywords: Airway Epithelium; Asthma; Drug reactions; Inflammation; Viral infection.