Pulmonary Immunocompromise in Chronic and High-dose Steroid Therapy
Mohleen Kang1, Rodrigo Cavallazzi2
1Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, 615 Michael Street NE Suite 205, Atlanta, GA 30322, USA; Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, GA, USA.
Clinics in Chest Medicine
|January 31, 2025
Summary
Glucocorticoids (GCs) are widely used but increase infection risk. This review details GC-induced pulmonary immunocompromise, focusing on prevention and management strategies to minimize patient complications.
Area of Science:
- Immunology
- Pulmonology
- Pharmacology
Background:
- Glucocorticoids (GCs) are essential treatments for various conditions including pulmonary, autoimmune, allergic, and oncologic diseases, and organ transplantation.
- GC use affects an estimated 1-2% of the global population, highlighting its widespread application.
- GC therapy is linked to severe infectious complications, including bacterial, mycobacterial, and opportunistic infections like Pneumocystis pneumonia and invasive fungal infections.
Purpose of the Study:
- To review the prevalence of glucocorticoid prescriptions.
- To summarize the mechanisms and manifestations of pulmonary immunocompromise induced by GCs.
- To outline mitigation strategies for managing infections in patients on chronic and high-dose steroid therapy.
Main Methods:
- Literature review of studies on glucocorticoid use and associated pulmonary complications.
- Analysis of infection prevalence and types in patients receiving GCs.
- Synthesis of data on GC mechanisms, clinical manifestations, and preventative measures.
Main Results:
- GCs are frequently prescribed for numerous diseases, with significant global usage.
- A range of pulmonary infections, including bacterial, mycobacterial, and opportunistic pathogens, are associated with GC use.
- Minimizing GC dosage and duration is crucial for reducing infectious risks.
Conclusions:
- Pulmonary immunocompromise is a significant risk associated with chronic and high-dose glucocorticoid therapy.
- Effective management requires careful monitoring for infections and implementing strategies to minimize GC exposure.
- Optimizing GC treatment involves balancing therapeutic benefits with the risk of infectious complications.
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