From the Guidelines
Corticosteroids should be used in asthma exacerbations even when viral infections are present, as they reduce the risk of recurrence and improve symptoms. The National Asthma Education and Prevention Program Expert Panel recommends that all patients presenting with an asthma exacerbation should receive systemic corticosteroids as part of their primary treatment, regardless of the presence of a viral infection 1. This is because viral triggers often precipitate asthma exacerbations by increasing airway inflammation and hyperresponsiveness, and corticosteroids work by suppressing this inflammatory cascade, reducing mucus production, and decreasing airway edema.
Some key points to consider when using corticosteroids in asthma exacerbations with concomitant viral infections include:
- The dose and frequency of administration of corticosteroids should be dependent on the severity of the exacerbation, with patients typically receiving 3 to 10 days of corticosteroid therapy to reduce the risk of recurrence 1
- Inhaled corticosteroids should be continued or initiated during the exacerbation to help control airway inflammation
- Patients should continue their regular asthma medications and stay hydrated while using corticosteroids
- Short courses of steroids rarely cause significant side effects or serious immunosuppression that would worsen viral infections, and withholding steroids during virus-triggered exacerbations may lead to prolonged symptoms and increased risk of hospitalization
It is essential to note that the benefits of steroids in controlling airway inflammation outweigh potential risks during viral infections, and corticosteroid therapy should be prescribed for 3 to 10 days to reduce the risk of recurrence, as recommended by the NAEPP Expert Panel 1. By following these guidelines, clinicians can effectively manage asthma exacerbations with concomitant viral infections and improve patient outcomes.
From the FDA Drug Label
Corticosteroids, including prednisone tablets, suppress the immune system and increase the risk of infection with any pathogen, including viral, bacterial, fungal, protozoan, or helminthic pathogens Corticosteroids can: • Reduce resistance to new infections • Exacerbate existing infections • Increase the risk of disseminated infections • Increase the risk of reactivation or exacerbation of latent infections • Mask some signs of infection Varicella and measles can have a serious or even fatal course in non-immune patients taking corticosteroids, including prednisone tablets
The role of corticosteroid (steroid) therapy in managing asthma exacerbations with concomitant viral infections is to be used with caution, as corticosteroids can:
- Increase the risk of infection
- Exacerbate existing infections
- Mask some signs of infection It is essential to monitor for the development of infection and consider prednisone tablets withdrawal or dosage reduction as needed 2.
From the Research
Role of Corticosteroid Therapy in Managing Asthma Exacerbations with Concomitant Viral Infections
- Corticosteroid therapy is effective in managing asthma exacerbations, including those with concomitant viral infections 3, 4, 5.
- Systemic corticosteroids are recommended for upper respiratory tract infection-induced asthma exacerbation, but may inhibit cellular immunity against respiratory virus infection 4.
- The combination of a leukotriene receptor antagonist and systemic corticosteroid may be more useful than corticosteroid alone for treating viral infection-induced acute exacerbation of asthma and reducing the cumulative corticosteroid dose 4.
- Inhaled corticosteroids decrease the risk of asthma exacerbations and can be used as-needed to empower patients to adjust their intake in response to symptom fluctuation 6, 7.
Benefits and Risks of Corticosteroid Therapy
- Short courses of systemic corticosteroids are associated with increased risk of adverse events, including loss of bone density, hypertension, and gastrointestinal ulcers/bleeds, as well as serious impacts on mental health 3.
- The benefits of corticosteroid therapy must be balanced against the risks, and strategies to improve asthma control, such as as-needed combination therapies and biologics, are recommended 3, 6, 5.
Viral Infections and Asthma Exacerbations
- Viral infections are a common trigger of asthma exacerbations, with respiratory syncytial virus, rhinoviruses, influenza, and parainfluenza virus being the most common viral pathogens associated with asthma 5.
- Asthmatics are more prone to severe viral infections due to their unique inflammatory response, which is mostly characterized by T2 cytokines 5.