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I keep getting messages about the doctor in West Texas saying he has a "cure" for Covid-19!
So what is his cure? He is using a drug called Budesonide with a trade name Pulmicort. It comes in an inhaler or a nebulizer solution. He is using this along with an antibiotic and Zinc. First off there is good evidence that steroids work as we discussed previously in the Recovery Trial. I have been using inhaled steroids with patients once we realized that they were not harmful and I believe they are helping. I am not overly convinced yet but I certainly do not think they present any risks.

Remember the initial information from China showed potential evidence that patients got worse on steroids, so I personally didn't use them in March and April. However, in late May when it appeared that steroids were not harmful, I started adding inhaled steroids like we use for viral pneumonia's. Inhaled steroids are relatively inexpensive and likely safe since it is working almost entirely in the lungs and very little is systemically absorbed.

So does it help? Yes I believe it very possibly does knowing the results of the Recovery Trial with dexamethasone. .We use inhaled steroids every day for asthma and COPD. There are many forms of inhaled steroids that will likely help also. The advantage Budesonide has is that it comes in a nebulizer form. This allows you to get higher concentrations in the lung. It decreases the inflammation in the lungs. It is commonly used in the treatment of pneumonia and bronchitis. The use of an antibiotic covers for secondary infections or if was bacterial to begin with.

Just like a criticized the HCQ/Zpak trial in Brazil since they did not have confirmed PCR tests only CT scans, the antibiotic could be skewing the results by treating bacterial infections. He mentioned himself that a significant number of his patients are having negative tests. He calls them 30% false positives but there is no evidence of this. It certainly could be a bacterial infection being misdiagnosed at Covid-19. Without some confirmation antibody testing there really is no way to tell.
Because it is not highly systemically absorbed the side effects and risks are minimal so worth trying. Until we have more clinical trials it is technically anecdotal evidence much like we are seeing with hydroxychloroquine just on an even much smaller scale.

In addition, he could be treating all lower risk patients who would likely recover even without treatment. We need patient demographics like age, risk factors to really see who is potentially responding. There is a big difference in the hospitalization and mortality rates between a healthy 45 y/o vs 75 y/o obese diabetic patient with heart disease.

I disagree with him on not needing a vaccine. While this may turn out to be an effective treatment it is a long way from a cure. Many patients in the hospital have very little inflammation in the lungs. This disease attacks the endothelial lining of many organs and blood vessels, not just the lungs. So there is still a lot of doubt as to whether this will work as well as the systemic steroids which was what was used in the Recovery Trial. And even then in the Recovery Trial steroids were only effective in patients who were sick enough to require oxygen. Patients actually did worse in the group that did receive steroids but did not require oxygen.

It is certainly safer to use steroids locally and not systemically, but will it help someone with clots elsewhere? Will it be potent enough to prevent endothelial damage in the gut, heart, kidneys etc? There are still many many questions to be answered long before anyone can claim they have the "silver bullet" for Covid-19. If you haven't seen it you can watch it here if you wish.

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