key: cord-0983926-qugexvup authors: Ausset, Antoine; Pop, Monica title: Letter to Sarah Basin et al. date: 2022-03-05 journal: Respir Med Res DOI: 10.1016/j.resmer.2022.100895 sha: dda696f7ebe61c14203a026e9e1f5c301fdf3703 doc_id: 983926 cord_uid: qugexvup nan We read with interest the work of Sarah Basin et al [1] . who are to be congratulated for their counter intuitive insight into the assessment of risk in patients with chronic respiratory diseases and we fully agree with them when they conclude that this category of patients is under-represented among those who will present the most severe forms of Covid 19. However, in claiming that they are the first to provide such data, they are leaving out substantial data from the literature that have led to meta-analyses showing an apparent protective role of chronic respiratory diseases [2] , especially for asthma [3] . These collections of observational data have recently been enriched by data from the "Open Safely" [4] and "Isaric" cohorts [5] , suggesting that only the most severe forms of these respiratory diseases constitute an excess risk. The latter study also suggests a protective role for inhaled steroids in the treatment of these chronic diseases and this point is also mentioned by Sarah Basin et al., but again they neglect to mention the results of five randomized trials evaluating the impact of inhaled steroids in the early stages of the disease [6−10] . These trials, although varying in the endpoints, appear to be consistent in finding beneficial effects of inhaled steroids, such as reduced use of emergency care [7, 8] and reduced duration of symptoms. The data of Basin et al. are thus totally consistent with the recent findings of the medical literature contributing to a better understanding of the risk assessment of our patients, confirming that treatment with inhaled steroids should be maintained and strengthening the hypothesis that the introduction of these agents could be a useful therapeutic contribution in the moderate forms of COVID. Four ongoing clinical trials addressing this issue, NCT04355637, NCT04356495, NCT04381364, and NCT04920838, although subject to inclusion difficulties related to variations could clarify their indications. None. Progression to a severe form of COVID-19 among patients with chronic respiratory diseases Reduced risk of COVID-19 hospitalization in asthmatic and COPD patients−A benefit of inhaled corticosteroids? Asthma and Coronavirus Disease 2019 Risk: a systematic review and meta-analysis Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids−An observational cohort study using the OpenSAFELY platform Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19: A Randomized Clinical Trial Ciclesonide inhaler treatment for mild-to-moderate COVID-19−A randomized, open-label, phase 2 trial Inhaled and intranasal ciclesonide for the treatment of covid-19 in adult outpatients: CONTAIN phase II randomised controlled trial