Common asthma drug cuts Covid-19 hospitalization, recovery time – Oxford study | Hacker News Reader

Common asthma drug cuts Covid-19 hospitalization, recovery time – Oxford study

reuters.com

156 pointstempestn63 comments

Link to the pre-print since jounalists always seem incapable of doing so:

https://www.medrxiv.org/content/10.1101/2021.02.04.21251134v...

Journalists' job isn't to point you at real original information, it is to keep you from accessing the real stuff and to come back to their newspaper.

This is implicitly true, as much as people don't want to hear that journalists aren't saints. The incentive structure in place doesn't motivate the journalism indistry to rigorously cite or investigate sources. There's no more money in it for most publications, and no other regulatory pressure. Why would anyone believe that the first duty of a journalist today is to anything besides their publication? It's the same reason that we on HN complain about privacy violations, censorship, annoying web ads, Google AMP, scrolljacking, sticky headers, and yet we are the ones who implement all that crap. At the end of the day, we are being paid to make our companies money. Any idealism is a nice-to-have on the side, but rarely is it our delegated mission.

> Why would anyone believe that the first duty of a journalist today is to anything besides their publication?

Your point about news websites' disincentive to link outbound is taken, but plenty of journalists (most?) are freelancers. Probably it's the paper's editors who feel those incentives.

Because if they didn't, everyone would just go to Medrxiv and browse the latest academic papers every day directly I suppose.

I have asthma and take this along with Montelukast which is also studied in various places now as Covid treatment. I have allergic rhinitis asthma which means I've lost my sense of smell and taste for months from allergic cytokine storm. My grandma took Budesonide her whole life and the side effect is she lost all pain-sensing in her skin (hit her leg on a stool and didn't notice she needed 80 stitches. But that was after 60 years on it. I'm allergic to basically all forms of animal and plant life.

Snap, been taking budesonide for about 5 years now. It was a massive improvement to my quality of life and I have basically zero asthma symptoms now as a result. My doctor tried to take me down to a weaker alternative medicine but I shot that down straight away. It's been the next best thing to a cure for me.

24yrs ago I took a Buteyko breathing course. Basically cured my asthma, I went about 16yrs without taking medication (this was down from taking around 4 doses per day). I've had a few flare ups in the last few years due to environmental changes but it is under control again now. I'd recommend this over taking drugs. https://www.buteykobreathing.org/

I've already tried stopping and reducing my medication. All that does is end up with me being hospitalised. I don't have mild asthma, I have chronic asthma. That's not the kind of thing you can heal with breathing techniques.

Yeah I had chronic asthma as well, I was hospitalised multiple times and I'd been on medication for 16yrs. I learnt the techniques and over 6months as I felt comfortable I was able to reduce my medication. You'd be mad to just stop your medication cold turkey. I'm not advocating that.

Have you tried?

It may or may not solve the problem but has the potential to cut away some of the anxiety and trauma connected to not getting enough oxygen.

From the website

It is not a cure for asthma but a complementary technique. This means that people using Buteyko should still continue take their inhalers as prescribed however research has shown that inhaler use can significantly reduce over time.

>I'm allergic to basically all forms of animal and plant life

From an evolutionary perspective, that's remarkable. Have you looked into the possibility that it's not your allergies, per se, but your microbiome that is the troublemaker?

Yep.It's a long complicated boring story but I lived in a car from the ages 2-4 (kidnapped by my dad). During that time (we had no money and were on the run from the RCMP) we ate only fish. Once I was 'rescued' by the RCMP I was returned home but lived there only briefly then left home young and lived on the road/cars/in Colombia and various deserts because in South America and in deserts I have no allergies. This is a way of saying the food doesn't matter ( I was raw food vegan for 3 years; vegetarian for 20 and eating very very simple foods as I am happy that way as any)

Out of curiosity, what does your diet look like?

have you (or the child comments) considered going plant based? It's shown to lower inflammation and improve the gut microbiome, which also improves immune response and lung function.

Several members of my family have improved their asthma symptoms by cleaning up their diet, allowing them to get off medication.

I know many issues people have are genetic, but the amount caused by a poor or incompatible diet are incredible.

Interesting. The drug is a steroid called budesonide. Here’s the study in question, a preprint!, on medrxiv: https://doi.org/10.1101/2021.02.04.21251134

I just found a 1992 paper on some details of budesonide. If I understand it correctly, then budesonide has an effect on platelet aggregation of serotonin via the 5-HT2A receptor. (Which I haven’t learned to be common among steroids? But I’m a layman, so!)

The paper: Inhaled budesonide regimen enhances serotonin- and arachidonic acid-induced platelet aggregation – https://doi.org/10.1007/BF01991227

Platelet and serotonin interaction are intimately involved in inflammation and clotting. This interests me in connection with the randomized controlled trial study showing successful use of the SSRI fluvoxamine in managing severe COVID-19 cases, as defined by a measure of preventing clinical deterioration: https://doi.org/10.1001/jama.2020.22760

Also in relation with the quite sound-looking theory that the serotonin metabolism in the lung (a known aspect of the global serotonin mechanism) can be hit by the endothelial damage and inflammation in COVID-19, having the potential to cause a runaway feedback loop of inflammation and abnormal clotting. Platelets store serotonin, and serotonin is an immunomodulator, usually increasing inflammation in tissue, as well as usually causing veins and capillaries to contract. (As far as I understand things.) As yet unverified by a controlled trial, but there is a strong and clear theoretical basis and strong anecdotal indications. More info here: https://mobile.twitter.com/farid__jalali/status/133547064688...

CORRECTION: The paper seems to indicate that budesonide has an effect of increasing the effect of serotonin to induce aggregation of blood platelets, theorized to happen via the 5-HT2A serotonin receptor.

Bad layman, bad!

doesn't LSD affect those receptors (5ht2a)?

It does! Thanks for asking, because:

CORRECTION: I must correct my lay hands’ pollution of the information on paper. The ‘92 study on budesonide makes an indicative argument towards action on the 5-HT2 receptor subtype. I mistakenly overspecified the 5-HT2A sub-subtype. I hope it isn’t grievously incorrect. There are three 5-HT2 receptor subtypes, A, B, and C: https://en.wikipedia.org/wiki/5-HT2_receptor – according to the individual Wikipedia entries, the 5-HT2A subtype is highly expressed on platelets, and the 5-HT2B is also expressed. No mention of platelets for the 5-HT2C subtype.

It is indeed true that psychedelics are generally known as agonists of the 5-HT2A receptor. Seemingly they tend to be agonists of the B and C subtypes as well, as per Wikipedia.

And interestingly enough, the substances known as psychedelics are also very significant and notable immunomodulators! As per this paper: Psychedelics and immunomodulation: novel approaches and therapeutic opportunities – A. Szabo, Frontiers of Immunology, 2015 – https://doi.org/10.3389/fimmu.2015.00358

(I want to mention author A. Szabo’s credentials: The 2015 paper cites the researcher’s position at Department of Immunology, Faculty of Medicine, University of Debrecen, Hungary. Subsequent publications show a position at the NORMENT Center of Excellence (CoE), Institute of Clinical Medicine, University of Oslo and the Department of Medical Genetics, both at Oslo University Hospital, Norway. Source: https://loop.frontiersin.org/people/193869/overview – There is reason to assume that this is a serious and capable person.)

There is mention of the Sigma-1 receptor as well in Szabo’s 2015 paper on immunomodulation. I want to take great care to not make spurious connections, but I did find this paper curious and interesting in this context: Repurposing Sigma-1 Receptor Ligands for COVID-19 Therapy? - J. M. Vela, Frontiers of Immunology, November 2020 – https://www.frontiersin.org/articles/10.3389/fphar.2020.5823...

Via: https://twitter.com/EricLenze2/status/1364459057629773824

It would be interesting to know if all inhaled steroids for asthmatics had a similar effect, or only this particular one. The steroid mentioned in this article is actually an older one, there are newer and more effective steroids that are often prescribed now. I wonder if they all work similarly in helping Covid patients.

It would also be curious to know if people who are already taking the steroids have possible benefits for Covid illness, or if its main benefit is if it started at the onset of illness.

In the Oxford PR (and perhaps also in the medarxiv pre print, I don’t remember and am on phone now), it said the reason for starting this trial was that people with asthma are significantly underrepresented among COViD19 patients (you would expect them to be on par or even over represented as they start from a worse breathing baseline).

Also, dexamethasone, a systemic steroid, seems to have comparable effects; likely, they both reduce or stop the damage from overactive immune response, which is likely a big part of covid complications.

Recent research indicates that methylprednisolone is more effective than dexamethasone as a steroid treatment.

https://doi.org/10.1101/2021.02.03.21251088

There seems to be a twist to budesonide: Inhaled budesonide regimen enhances serotonin- and arachidonic acid-induced platelet aggregation [via the 5-HT2A serotonin receptor?] – https://doi.org/10.1007/BF01991227

You posted this twice but failed to explain what the twist is.

Thank you for sharing your interpretation.

For avoidance of doubt, this is the twist:

Inhaled budesonide regimen enhances serotonin- and arachidonic acid-induced platelet aggregation [via the 5-HT2A serotonin receptor?] – https://doi.org/10.1007/BF01991227

Edit: In the light of downvotes - which I receive with kindness and in good spirits - then - again purely for avoidance of doubt - I want to confirm that this is the message.

Very interesting, and as the article says, perhaps explains why smokers were so underrepresented in Covid cases. 90% drop is a lot.

...just waiting for that result to be destroyed now. That said, the UK studies have been quite solid so far.

Interesting. I got COVID-19 in December 2020, and feared the outcome because I'm asthmatic and have a history of mild allergy and inflammation. It was bad, but I've had worse flus, so all in all it was a good outcome.

My doctor gave me a shotgun cocktail of prednisone (another glucocorticoid), Azitromicyn, Ivermectin, Ibuprofen and Aspirin. More likely I was one of the majority that don't develop grave symptoms, but maybe the Prednisone played a part, as Azitromicyn and Ivermectin are no longer recommended as treatment because their effect at normal doses is questionable.

Is it irrational for me, an asthmatic who uses budesonide daily, to be worried that the cost of this drug is going to skyrocket and make my prescriptions expensive?

This has already happened with other drugs whose usage increased significant as a result of the pandemic

I have wondered if AstraZenica ending the prescription copay support program last summer was in response to an anticipated huge patient increase due to covid.

Reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation.

https://en.wikipedia.org/wiki/Budesonide#Pharmacology

So one of the things it does is it impacts the circulatory system. Covid has significant impact on the blood and this fact seems to account for a lot of things that went badly sideways in ways that weren't readily understood. For example, ventilators were getting especially poor results, from which I infer that the respiratory element of the infection isn't the primary way it kills most people.

Steroids generally support immune function and are often prescribed alongside antibiotics for serious infections. They are hard on the body and getting off steroids is the hardest withdrawal experience I ever had out of the dozen or more medications I eventually got off of. I have been told by other people that, yup, getting off steroids is typically a real bitch (though there are things that can be done to mitigate it, which is how I eventually successfully got off of them).

I read the preprint and the supplementary data and it is interesting, but what I can't find, and I don't know why they don't include it, is a breakdown of events in the primary outcomes.

In this study, primary outcome was a combination of: hospitalization, urgent care visit, or emergency room visit. There were 10 in the placebo and 1 in the budesonide group. But I can't find whether those events, or what proportion, were hospitalizations vs ER vs urgent care visits. If I'm missing something someone please correct me. To me it would not be a great therapeutic option if, for example and I'm making this up, the budesonide group had 1 hospitalization and the placebo had 10 urgent care visits.

Also the number of patients was ~146, would like to see much higher numbers to catch what's significant to me, which is percent hospitalization. If you read their methods they created the study under the assumption that "20% of COVID-19 patients would be severe", when it was designed back in March which is a bit high.

I remember back in June 2020 when Dr. Richard Bartlett called this drug a silver bullet. I was hopeful it would be considered for widespread use. When the media slapped labels on the articles and inserted other doctor's comments about lacking scientific data, I was dismayed.

See how coverage of the same drug for a novel treatment was different pre covid:

https://www.ksat.com/news/2019/11/13/new-drug-delivery-relie...

Post covid:

https://www.ksat.com/news/local/2020/07/14/is-inhaled-steroi...

I was goiven Pulmicort inhalations back on March 14, 2020 when I got COVID19. Not sure if it helped (male 38, normal weight) as it hit me really hard but I did not need to go to the ER. It was some of the worst 2 months of my life, until I took something else that really helped me.

The first article is coverage of a delivery method for an already approved use, not the medication itself.

Wonder if Twitter will block this as misinformation if it’s not blessed by the WHO or CDC. Remember all those other small studies that looked at Vit-D and other drugs that showed they might help but got labeled or banned by Twitter as not official possibly misinformation?

"There's an interesting study out that shows X may help with COVID" won't get you banned.

"X cures COVID 100% and the WHO is suppressing it to help Big Pharma!" will. (Might. Enforcement is spotty.)

And inconsistent.

Think about the thousands of humans with bias involved in those decisions one by one.

No, I don't remember that. I do remember Twitter banning people making wild claims on the basis of studies that didn't support those claims, of course.

And what people remember, in a number of cases, is linked to their biases.

Inhaled steroid. Already have data that a systemic steroid (dexamethasone) works. Not an altogether surprising outcome, but a welcome addition to possible treatments as the systemic effects can be avoided.

What about symbicort (budesonide + Formoterol)?

What about salmeterol + fluticasone?

I know the answers are not there in the article, but do you suppose that the results would be same / similar?

Interesting, the world (the first world at least) is well stocked with Pulmicort and it's dead simple and quite safe to administer.

Guess I'll take this one upside over no upsides of having asthma. (I'm on Symbicort, which is basically part this and part formoterol).

I’m not surprised at the link — I’m a young person, I got covid in June, and I’ve been having a lot of asthma problems (which I didn’t have before). Super frustrating.

This is the first drug that actually works in the initial stages, isn't it?

No, it isn’t. There’s at least one steroid (dexamethasone) and There are at least three other off label treatments which have shown some efficiency at early stages (IVermectin, hydrochloroquine, and another one whose name escapes me).

Of these, ivermectin’s safety profile is “incredibly safe”, hcq “mostly safe with some caveats”; don’t remember about cholcocine or whatever it is called.

I am perplexed at the complete and utter avoidance from western countries (including US, Britain and Israel) of these.

Yes, vaccines are a better solution long term, and it is good to give them high priority. But there isn’t really a competition for resources here. I just can’t understand it.

>I am perplexed at the complete and utter avoidance from western countries (including US, Britain and Israel) of these.

Dexamethasone's effects were discovered by a study in the UK, and: "Changes in the NHS covid-19 treatment protocol were soon announced based on these results". My wife confirms this, she's a nurse.

https://www.bmj.com/content/370/bmj.m2648

Hydrochloroquine is not effective as a Covid-19 treatment: "However, available evidence does not support the use of this medication in the prevention or treatment of COVID-19."

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9...

As for ivermectin: "Ivermectin inhibits the replication of SARS-CoV-2 in vitro at concentrations not readily achievable with currently approved doses. There is limited evidence to support its clinical use in COVID-19 patients."

Although they do recommend further studies. It seems it could be useful, but there are alternative treatments available now that are more effective.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...

> I am perplexed at the complete and utter avoidance from western countries (including US, Britain and Israel) of these.

Dexamethasone is a standard treatment in the UK in line with WHO guidance[1]. Its use was first recommended in June 2020, before the final analysis of the RECOVERY study results was even published[2]. I was treated with it in October 2016.

Hydroxychloroquine was trialed, and found not to be effective in hospitalised patients[3].

[1] https://www.england.nhs.uk/wp-content/uploads/2020/11/C0870_...

[2] https://www.gpni.co.uk/wp-content/uploads/2020/06/DEXAMETHAS...

[3] "On 5 June 2020, the trial determined that there was no clinical benefit from use of hydroxychloroquine in people hospitalized with COVID-19." https://en.wikipedia.org/wiki/RECOVERY_Trial#Hydroxychloroqu...

Can you post some references to studies showing these drugs' efficacy? (apart from dexamentazone which is of course known to have been shown to be effective already).

For HCQ, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534595/

There's another site I cannot remember the domain of now, that aggregates as many studies as it can find. It claims something like 2/3 of studies show positive effects.

Edit: Found it, and it includes links at the top for similar sites on Ivermectin, Vitamin D, Zinc, etc - https://c19study.com/

https://c19ivermectin.com/

Reddit.com/r/ivermectine

Correct Reddit link:

https://www.reddit.com/r/ivermectin

The US bought millions of doses of hydrochloroquine. If it worked, we'd be using it, not wondering what to do with it.

Zinc!, Vitamin C!, the other thing!

HCQ might still be useful if administered with zinc, that's been the working theory since the beginning but has been lost in the madness. There's at least one study to that effect, which incidentally goes to great lengths to hide the fact that they are using HCQ to boost intracellular zinc concentration. Zinc has been known to slow viral replication, so that makes people deficient in it more vulnerable.

I think I recall reading that study and seeing it compared people who took zinc with HCQ with people in the hospital and concluded that people in the hospital died more often than mostly healthy people. Hardly what I would call useful information.

Zinc!

Common asthma drug if that's all you're after: the steroid budesonide

Clickbait shmickbait

I'm not sure how that's clickbait? It's useful context for the vast, vast majority of people who have no idea what budesonide is; putting that in the headline would be quite unhelpful.

"Common asthma drug budesonide cuts Covid-19 etc." would be more informative than leaving the word out. I have never heard of budesonide before, but this way I would know that it's a common asthma drug.

It is also possible to read beyond just the headline though; not all information has to be crammed in there. As it was, the article's headline was already slightly too long for HN, so I shortened 'hospitalization risk' to just 'hospitalization'.

I have asthma, I clicked to see if it was the medication I'm on. It was not. I lost interest in the article.

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