Glucocorticoid Therapy in Respiratory Illness: Bench to Bedside

Abstract

Each year, hundreds of millions of individuals are affected by respiratory disease leading to approximately 4 million deaths. Most respiratory pathologies involve substantially dysregulated immune processes that either fail to resolve the underlying process or actively exacerbate the disease. Therefore, clinicians have long considered immune-modulating corticosteroids (CSs), particularly glucocorticoids (GCs), as a critical tool for management of a wide spectrum of respiratory conditions. However, the complex interplay between effectiveness, risks and side effects can lead to different results, depending on the disease in consideration. In this comprehensive review, we present a summary of the bench and the bedside evidence regarding GC treatment in a spectrum of respiratory illnesses. We first describe here the experimental evidence of GC effects in the distal airways and/or parenchyma, both in vitro and in disease-specific animal studies, then we evaluate the recent clinical evidence regarding GC treatment in over 20 respiratory pathologies. Overall, CS remain a critical tool in the management of respiratory illness, but their benefits are dependent on the underlying pathology and should be weighed against patient-specific risks.

Tezepelumab improved chronic eosinophilic pneumonia in severe asthma patients with liver cirrhosis

“…In the treatment of CEP, the recommended initial OCS dose is 0.5 mg/kg, and because the patient weighed 49.4 kg, 25 mg/day would usually be used ( 1 ). However, this case was complicated by uncompensated LC.…”

“…Asthma and chronic eosinophilic pneumonia (CEP) can be comorbid, and studies have shown that oral corticosteroids (OCSs) are successful in treating CEP ( 1 ). The metabolism of corticosteroids (CSs) in the liver is impaired in patients with severe liver cirrhosis (LC), and CS may further aggravate liver function and increase the risk of impaired consciousness by elevating the amount of circulating NH 3 ( 2 ).…”

Pneumonia in newly diagnosed patients infected with the Omicron variant: a population-based study of Chinese patients in Chongqing

“…For patients with contraindications or who failed prevention, thrombosis was still an important factor affecting prognosis. Steroid, as a type of anti-inflammatory drug, can effectively promote the absorption of pneumonia 14. In clinical practice, we often prescribed the dose of steroid according to the severity (determined by patients’ symptoms, imaging manifestations and blood gas indexes).…”

High Throughput Quantitation of Human Neutrophil Recruitment and Functional Responses in an Air-Blood Barrier Array

“…Modulating neutrophilic inflammation has historically been challenging in respiratory medicine 1,2 despite an expanding pool of immunomodulators available for clinical use [3][4][5][6] . A major bottleneck has been the lack of preclinical screening tools that adequately capture human-specific neutrophil responses such as priming while in the circulation, pathological recruitment into tissues, and the secondary acquisition of dysfunctional states therein 2,[7][8][9] .…”