- Theoretically, corticosteroids suppress lung inflammation in acute lung injury and acute respiratory distress syndrome (ARDS).
- However, by inhibiting host immune responses they also inhibit pathogen clearance.
- Possible harm was shown with its use in other respiratory infections including:
- Delayed viral clearance (SARS-CoV and MERS-CoV)
- Increased secondary infection (influenza)
- Increased mortality and length of stay in ICU (influenza)
- No good evidence suggests the benefit derived from corticosteroids in the treatment of respiratory infections due to Respiratory Syncytial Virus RSV, influenza, SARS-CoV or MERS-CoV.
- Currently, it is not expected that corticosteroids are effective to treat patients with SARS-CoV-2 infection.
According to the WHO and CDC, corticosteroids in patients with COVID-19 pneumonia should be avoided unless there are other indications.
These statements come from a summary published in The Lancet reviewing clinical evidence on the use of corticosteroids in several severe respiratory virus infections. Almost all of the reviewed clinical evidence derived from observational studies. Limitations and biases of each clinical data were not thoroughly discussed in this summary. Corticosteroids are widely used in septic shock despite their uncertain efficacy. The potential benefit derived from steroid treatment mostly comes from bacterial infection cases leading to vasoplegic shock and myocardial insufficiency. It is unlikely that steroid treatment is effective against shock in severe hypoxemic respiratory failure, which is often not a consequence of vasoplegia but increased cardiac filling or impeding cardiac filling.
- Russell CD, Millar JE, Baillie JK (February 07 2020). Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. https://doi.org/10.1016/S0140-6736(20)30317-2
- World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance: Patient management. Updated March 13 2020 (Accessed on March 31 2020). https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
- Centers for Disease Control and Prevention. Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection, Updated March 30, 2020 (Accessed on March 31 2020). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
- Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). (Accessed on March 31 2020). https://www.sccm.org/getattachment/Disaster/SSC-COVID19-Critical-Care-Guidelines.pdf