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Systemic corticosteroids in acute chest syndrome: friend or foe?
Folasade Ogunlesi1, Matthew M Heeney2, Anastassios C Koumbourlis1
1Division of Pulmonary & Sleep Medicine, Children's National Medical Center/George Washington University, Washington DC.
Insights
Corticosteroids may benefit acute chest syndrome (ACS) in sickle cell disease (SCD) patients by reducing inflammation. However, their use is debated due to serious adverse effects like pain crises and stroke.
Area of Science:
- Hematology
- Pulmonology
- Pharmacology
Background:
- Acute chest syndrome (ACS) is a severe pulmonary complication in sickle cell disease (SCD).
- ACS is a leading cause of hospitalization and mortality in SCD patients, particularly in children.
- Potential triggers for ACS include infections, fat embolism, asthma, and ischemic reperfusion injury, all linked to inflammation.
Purpose of the Study:
- To review the evidence supporting and opposing the use of corticosteroids in managing ACS.
- To analyze the risk-benefit profile of different corticosteroids, dosing strategies, and the impact of comorbidities.
Main Methods:
- Literature review of studies investigating corticosteroid use in ACS.
- Analysis of reported benefits, adverse effects, and influencing factors.
Main Results:
- Corticosteroids demonstrate anti-inflammatory properties that can benefit ACS.
- Significant adverse effects, including rebound pain, stroke, and renal complications, lead to reluctance in their use.
- The choice of corticosteroid, dosage, and patient comorbidities influence the risk-benefit balance.
Conclusions:
- The use of corticosteroids in ACS requires careful consideration of potential benefits against serious risks.
- Further research is needed to optimize corticosteroid therapy for ACS in SCD patients.
Abstract:
Acute chest syndrome(ACS) is the most common pulmonary complication of sickle cell disease (SCD), the second most common cause of hospitalization and the primary cause of death in patients with sickle cell disease. Its highest prevalence is in early childhood. The pathogenesis of ACS is unknown but many predisposing conditions and mechanisms have been implicated including infections, pulmonary fat embolism, asthma and ischemic reperfusion injury. These conditions are associated with inflammation and therefore, the use of corticosteroids has been advocated because of their anti-inflammatory properties. Although, significant benefits from their use have been shown, there is great reluctance in using them because of reports of serious adverse effects, such as readmission to the hospital due rebound pain crisis, stroke, renal infarction, coma and even death. The current article reviews the evidence in favor and against the use of corticosteroids in ACS. Emphasis is given on the potential benefits vs. risks among the different types of corticosteroids, the importance of the dosing regimen and the role of underlying co-morbidities.
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