Corticosteroids or NSAIDs in Managing Acute Respiratory Infections: Valuable Differences

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for respiratory infections. These drugs work by blocking two enzymes, COX-1 and COX-2, which regulate the production of prostaglandins, mediators involved in pain, fever, and inflammation. Corticosteroids (CSs) are commonly used in outpatient settings for anti-inflammatory purposes in the treatment of infectious diseases. However, their potential side effects, such as immunosuppression and increased metabolism, can be overlooked, even at low doses. Their use is clearly defined for severe conditions. Other infections, such as community-acquired pneumonia, pharyngotonsillitis, or otitis, do not have supportive data for the use of systemic CSs. For COVID-19, CSs are beneficial for severe cases that require ventilation, while they may not be helpful in mild cases. Infection-induced inflammation is associated with oxidative stress, a condition that arises from an imbalance between reactive oxygen species (ROS) and inadequate antioxidant responses. This stress worsens inflammatory reactions and can lead to severe respiratory infections and tissue damage. Managing oxidative stress is crucial in treating respiratory infections, and both CSs and NSAIDs can help reduce it. NSAIDs are preferred for treating symptoms such as fever and pain during the early phases of infections, especially viral ones, without hindering the immune response. CSs are powerful anti-inflammatory medications that are useful for treating infections in patients with asthma or allergies. However, CSs are not recommended for relieving pain and fever and can weaken the immune response. Both NSAIDs and steroids can mask serious infections, so doctors must be cautious in their use.