Pulmonary Infections in Patients Receiving Corticosteroids and Other Immunomodulators

The prevalence of immunosuppression in the general population has been increasing over time due to a combination of factors, including advances in health care and the emergence of new therapies. Population-based studies show that approximately 3% of the population are prescribed systemic corticosteroid therapy at least once a year. Additionally, the number of immunomodulatory agents, such as biologics and small molecules, continues to grow. The chronic use of systemic corticosteroid and immunomodulating agents has an impact not only on the incidence of patients with pneumonia, but also on their microbiology, clinical presentation, and outcomes. Recent cohort studies show that chronic corticosteroid therapy is one of the leading causes of immunosuppression in patients with nosocomial pneumonia and community-acquired pneumonia requiring hospitalization. Different immunomodulating agents can have varying effects on the immune system; hence, each agent should be individually analyzed when assessing their impact on the immune system. Important factors to consider are the dose and duration of immunosuppressive medications, as well as their indication. Many of the conditions for which corticosteroids and immunomodulators are prescribed also lead to immunosuppression. In the study, we aim to assess the literature on the risk of pneumonia associated with the use of chronic systemic corticosteroid therapy and immunomodulating agents, particularly biologics and small molecules. We also discuss clinical manifestations and management of patients who develop pneumonia while on these therapies.