What is the recommended dose and type of steroid for treating edema due to respiratory infection in elderly patients?

From the Guidelines

For elderly patients with edema due to respiratory infection, oral prednisone at 20-40 mg daily for 5-7 days is typically recommended. This recommendation is based on the guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients, which suggests that corticosteroids can reduce mortality, shorten hospital stay, and reduce the need for mechanical ventilation in patients with severe pneumonia 1. The lower end of this dosage range is often preferred for elderly patients to minimize side effects, such as hyperglycemia, which has been reported to be increased with corticosteroid use (RR, 1.49; 95% CI, 1.01−2.19) 1.

Key Considerations

• Methylprednisolone may be used as an alternative at 16-32 mg daily.
• For hospitalized patients with severe symptoms, intravenous methylprednisolone at 40-60 mg daily might be necessary.
• Treatment duration should be kept short to reduce risks of adverse effects.
• Tapering is generally not required for short courses under 7-10 days.
• Baseline glucose levels should be checked, and patients should be monitored for changes in blood pressure and signs of infection during therapy.

Important Side Effects

• Hyperglycemia
• Fluid retention
• Hypertension
• Increased susceptibility to infections

Special Populations

• Patients with diabetes, heart failure, or active infections should be carefully considered for steroid therapy, as these conditions may be exacerbated.

From the FDA Drug Label

In other indications, initial dosage will vary from 10 mg to 40 mg of methylprednisolone depending on the specific disease entity being treated. However, in certain overwhelming, acute, life-threatening situations, administrations in dosages exceeding the usual dosages may be justified and may be in multiples of the oral dosages

The recommended dose and type of steroid for treating edema due to respiratory infection in elderly patients is not explicitly stated in the provided drug labels.

• Dose: The labels mention initial dosages ranging from 10 mg to 40 mg of methylprednisolone, but this is not specific to edema due to respiratory infection in elderly patients.
• Type: Methylprednisolone is the steroid mentioned, but its use for edema due to respiratory infection in elderly patients is not directly addressed. 2 2

From the Research

Recommended Dose and Type of Steroid

• The recommended dose and type of steroid for treating edema due to respiratory infection in elderly patients is not explicitly stated in the provided studies. However, some studies suggest the following:
  • Dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg, as initial doses for acute airway obstruction 3
  • Methylprednisolone, 20-40 mg every 4-6 hours, initiated 12-24 hours prior to a planned extubation in patients at high-risk for postextubation laryngeal edema 4

Steroid Effects on Edema

• Corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling, and their effect is nonspecific 3
• The steroid effect is local and directly proportional to the concentration of steroids in the inflamed tissue 3
• Corticosteroids may alter the reaction of the pulmonary vasculature to various stimuli or agents by influencing the release of mediators, modulating the action of mediators, reducing the activation of leukocytes and/or platelets, or changing the state of the pulmonary vascular muscle cells 5

Use of Steroids in Respiratory Infections

• Oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma because they do not reduce symptom duration or severity 6
• Prophylactic corticosteroid therapy can reduce the incidence of postextubation laryngeal edema and the subsequent need for reintubation in mechanically ventilated patients at high-risk for postextubation laryngeal edema 4