Corticosteroids for severe influenza pneumonia: A critical appraisal

Abstract

Influenza pneumonia is associated with high number of severe cases requiring hospital and intensive care unit (ICU) admissions with high mortality. Systemic steroids are proposed as a valid therapeutic option even though its effects are still controversial. Heterogeneity of published data regarding study design, population demographics, severity of illness, dosing, type and timing of corticosteroids administered constitute an important limitation for drawing robust conclusions. However, it is reasonable to admit that, as it was not found any advantage of corticosteroid therapy in so diverse conditions, such beneficial effects do not exist at all. Its administration is likely to increase overall mortality and such trend is consistent regardless of the quality as well as the sample size of studies. Moreover it was shown that corticosteroids might be associated with higher incidence of hospital-acquired pneumonia and longer duration of mechanical ventilation and ICU stay. Finally, it is reasonable to conclude that corticosteroids failed to demonstrate any beneficial effects in the treatment of patients with severe influenza infection. Thus its current use in severe influenza pneumonia should be restricted to very selected cases and in the setting of clinical trials.

Respiratory Barrier as a Safeguard and Regulator of Defense Against Influenza A Virus and Streptococcus pneumoniae

“…In vitro steroid treatment led to decreased epithelial permeability through the action of claudin-8 and occludin recruitment to TJs (211). However, corticosteroids were not found to be of benefit to patients during IAV infections (212,213). A Cochrane review and another meta-analysis highlighted significant heterogeneity in published studies and did not show benefit but instead had a trend toward increased mortality (214,215), and therefore, their efficacy as a therapy during influenza remains controversial.…”

Glucocorticoid Insensitivity in Virally Infected Airway Epithelial Cells Is Dependent on Transforming Growth Factor-β Activity

“…The most commonly used anti-inflammatory drugs for asthma and COPD exacerbations are glucocorticoids (GCs). However, the majority of clinical studies have found that respiratory viral infection responds inadequately to the anti-inflammatory actions of either inhaled or systemic GCs [19–25]. Moreover, the effect of GCs on virus-induced cytokine secretion is controversial.…”

Eosinophils Promote Antiviral Immunity in Mice Infected with Influenza A Virus

“…Paradoxically, retrospective studies investigating the 2009 influenza pandemic demonstrated that although asthmatics were more likely to be hospitalized, they were less likely to have complications or die of influenza compared with non-asthmatics (5)(6)(7)(8)(9). Although the use of corticosteroids has been proposed as one reason for this confounding observation (10), information on steroid therapy was not available in all reports surrounding the 2009 influenza pandemic, nor have steroids been found to be effective against influenza infections (11,12). Therefore, further investigation into the complex interplay between asthma and influenza is necessary.…”