Optimizing Inhaled Corticosteroid Delivery in Asthma After COVID-19: A Critical Narrative Review and Quality-of-Care Framework

Background and Objectives: Persistent cough, dyspnea, chest tightness, and exercise limitation after SARS-CoV-2 infection are common in people with asthma but are not specific to uncontrolled asthma. This critical narrative review evaluates inhaled corticosteroid (ICS) delivery optimization after COVID-19 while distinguishing direct post-COVID evidence from established asthma evidence. Materials and Methods: PubMed/MEDLINE was searched from January 2020 through 6 July 2026 for literature on asthma after COVID-19, ICS, inhaler technique, adherence, device selection, small-airway disease, chronic cough, rehabilitation, and severe-asthma care; relevant GINA (Global Initiative for Asthma), WHO (World Health Organization), NICE (National Institute for Health and Care Excellence), ERS (European Respiratory Society), and ATS (American Thoracic Society) guidance was also reviewed. The narrative synthesis drew on 89 cited sources, grouped by relevance, study design, and evidentiary directness. Results: Direct post-acute evidence is limited and predominantly observational. Post-acute asthma-control outcomes vary across cohorts; observational evidence suggests increased exacerbation risk, particularly after severe or hospitalized COVID-19. In the most directly relevant observational study, Tichopad et al. evaluated 654 patients with asthma and COVID-19 and found that a higher combined adherence/inhaler-technique score was associated with better recovery of lung-function measures and quality of life, without establishing causality. Evidence for adherence assessment, inhaler-technique correction, device-patient matching, and appropriate ICS-containing therapy is stronger in established asthma care. Extra-fine formulations may improve peripheral deposition in selected asthma phenotypes, whereas post-COVID air trapping alone does not establish corticosteroid responsiveness. Conclusions: COVID-19 history should trigger better asthma assessment, not automatic treatment intensification. Persistent symptoms should prompt confirmation of asthma relevance, assessment of objective and inflammatory features when appropriate, verification of adherence, inhaler technique, and device suitability, and consideration of non-asthma mechanisms before pharmacological escalation.