What is the role of steroids in the treatment of Respiratory Syncytial Virus (RSV) infection in elderly patients?

Steroids for RSV Treatment in Elderly Patients

Systemic corticosteroids are not recommended for the treatment of Respiratory Syncytial Virus (RSV) infection in elderly patients as they provide no clinical benefit and may potentially cause harm. 1

Evidence Against Steroid Use in RSV Treatment

• Short courses of systemic steroids in patients hospitalized with RSV infection do not affect viral load or viral shedding, while potentially blunting humoral immunity responses 1
• Systemic corticosteroid use in RSV-infected patients has been associated with longer hospitalization duration and increased risk of secondary bacterial infections 2
• Patients on systemic corticosteroids are at highest risk for hospitalization due to RSV compared to other patients with underlying conditions 3
• Elderly patients (≥60 years) with RSV infection who are on systemic corticosteroids have been identified as having the highest risk for severe outcomes 3

Current Standard of Care for RSV in Elderly

• The standard of care for RSV-infected elderly patients remains primarily supportive, including:

  • Fluid management 4
  • Antipyretics for fever control 4
  • Oxygen support when needed 4
  • Management of underlying conditions according to standard protocols 5

• For elderly patients with underlying respiratory conditions such as COPD or asthma, management should focus on treating exacerbations according to standard protocols rather than using steroids specifically for RSV 5

Prevention Rather Than Treatment

• Prevention through vaccination is now the recommended primary strategy for RSV in elderly populations 5

• RSV vaccination is recommended for:

  • All adults aged ≥75 years regardless of comorbidities 6, 5
  • Adults aged 60-74 years with risk factors 6, 5
  • All adults aged ≥60 years according to some guidelines 3

• Currently available RSV vaccines include:

  • RSVPreF3 OA (Arexvy) from GlaxoSmithKline 3
  • RSVpreF (Abrysvo) from Pfizer 3
  • mRESVIA (mRNA-1345) 3

High-Risk Elderly Populations

• Older adults (>60 years) are at increased risk for serious complications of RSV including:

  • Respiratory failure 3
  • Pneumonia 3
  • Mortality rates of 2-5% 3, 7

• Risk factors that further increase severity in elderly patients include:

  • Advanced age (≥75 years) 3, 6
  • Chronic respiratory diseases (COPD, asthma) 6
  • Cardiovascular diseases 6
  • Diabetes 3
  • Chronic kidney disease 3
  • Immunocompromised status 3
  • Residence in nursing homes or long-term care facilities 3, 6

Diagnostic Considerations

• Nucleic acid-based testing (RT-PCR) is recommended for diagnosis of RSV in elderly patients 5
• Testing is especially important in immunocompromised elderly patients 5
• Clinical presentation may include cough (93% of cases), nasal congestion, shortness of breath, and low-grade fever 8, 7

Conclusion on Steroid Use

• Despite their common use in respiratory conditions, systemic corticosteroids should be avoided specifically for RSV treatment in elderly patients 1
• The focus should be on supportive care and prevention through vaccination rather than steroid therapy 5, 4