CHEST Guidelines-The-Effect-of-Steroid-Use-in-Hospitalized-Adults-W

The-Effect-of-Steroid-Use-in-Hospitalized-Adults-W

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This study investigated the effects of systemic glucocorticosteroids (steroids) in adults hospitalized with respiratory syncytial virus (RSV)-related illnesses, such as COPD and asthma exacerbations. Conducted over three winters from 2005 to 2008 at Rochester General Hospital, the research aimed to understand if short-term high-dose steroid treatments influenced viral load, immune response, and clinical outcomes in these patients.<br /><br />A total of 111 RSV-positive patients participated, with 50 requiring hospitalization. Of these, 33 (66%) were treated with systemic steroids, typically receiving 4-10 mg of dexamethasone or 40-60 mg of methylprednisolone every 6 hours initially, followed by a prednisone taper. This treatment period averaged 11 days. The primary comparisons were made between those treated with steroids and those who were not.<br /><br />Key findings indicated no significant impact of steroid treatment on peak viral load or duration of viral shedding. Despite initial concerns, adaptive immune responses, involving lymphocyte counts and subsets, were largely unaffected by steroid use. However, the humoral immune response was slightly diminished, with the steroid-treated group showing modestly lower RSV-specific serum-neutralizing and nasal antibody titers. Clinically, there were no significant adverse virologic or clinical outcomes related to steroid treatment, such as increased instances of bacterial infections, severe hyperglycemia, or other complications typically associated with long-term steroid use.<br /><br />The study concludes that short-term systemic steroid use during RSV infections does not significantly alter viral dynamics or induce severe immune suppression, although it may modestly reduce humoral response. The immediate benefits of reduced inflammation and symptoms may outweigh the risks, especially since viral-specific respiratory infections are seldom diagnosed in adults. Thus, these findings provide reassurance regarding the safety of short-term steroid use in such clinical settings.

Keywords

systemic glucocorticosteroids

respiratory syncytial virus

COPD exacerbations

asthma exacerbations

immune response

viral load

dexamethasone

methylprednisolone

prednisone taper

humoral response