Systemic Corticosteroids for Treating Respiratory Diseases: Less Is Better, but… When and How Is It Possible in Real...

Area of Science:

• Pulmonology
• Pharmacology
• Endocrinology

Background:

• Systemic corticosteroids (CSs) possess potent anti-inflammatory properties, making them essential in managing various respiratory conditions.
• Despite their efficacy, CSs are associated with significant side effects, including hypothalamic-pituitary-adrenal (HPA) axis suppression and potential adrenal insufficiency.
• Minimizing CS dosage and duration is a key challenge in pharmacological research to ensure safe and effective treatment.

Purpose of the Study:

• To review the indications for CS use in respiratory diseases.
• To analyze optimal CS types, dosages, and treatment durations, emphasizing minimization.
• To discuss strategies for safe CS tapering and management of adrenal insufficiency.

Main Methods:

• This narrative review synthesized existing literature on corticosteroid use in respiratory diseases.
• Examined current guidelines for CS prescription in conditions like asthma, COPD, COVID-19 pneumonia, ARDS, and interstitial lung diseases.
• Analyzed data regarding CS dosages, treatment lengths, and monitoring for adrenal insufficiency.

Main Results:

• Chronic CS treatment is linked to poor prognosis but remains common in severe asthma, COPD, and interstitial lung diseases.
• Guidelines recommend short-term methylprednisolone (20-40 mg/day) for COVID-19 pneumonia, asthma, and COPD exacerbations.
• Short CS courses (<10-14 days) may be stopped abruptly with monitoring for adrenal insufficiency; longer courses require gradual tapering and HPA axis evaluation.

Conclusions:

• Safe corticosteroid use in pulmonology necessitates minimizing dosage and duration.
• Careful monitoring and assessment for adrenal insufficiency are vital, especially after prolonged or high-dose CS treatment.
• Gradual tapering and HPA axis evaluation support safe CS withdrawal when indicated.