Are corticosteroid (CS) inhalers effective in treating pneumonia?

From the Guidelines

Corticosteroid inhalers are not recommended for treating pneumonia, as they are primarily used for asthma and COPD management and cannot effectively reach the infected lung tissue. Instead, pneumonia requires systemic antibiotics for bacterial causes or antivirals for certain viral pneumonias. For bacterial pneumonia, appropriate antibiotics like amoxicillin (500mg three times daily for 5-7 days), azithromycin (500mg once daily for 3-5 days), or doxycycline (100mg twice daily for 5-7 days) are typically prescribed based on the suspected pathogen and local resistance patterns 1. In some severe cases of pneumonia, systemic corticosteroids (like prednisone or dexamethasone) may be used alongside antibiotics to reduce inflammation, but these are given orally or intravenously, not via inhalers, as suggested by recent studies 1. The use of corticosteroids in pneumonia is generally not recommended, except in specific cases of severe pneumonia with septic shock refractory to fluid resuscitation and vasopressor use, where methylprednisolone 0.5 mg/Kg IV every 12 hours for 5 days or prednisone 50 mg daily may be considered 1. However, caution is advised in the setting of viral CAP, as meta-analyses in influenza patients show increased mortality with corticosteroid use 1. It is essential to seek medical attention for proper diagnosis and treatment rather than using corticosteroid inhalers if pneumonia symptoms (fever, cough with phlegm, chest pain, difficulty breathing) are present. Key points to consider include:

• Pneumonia treatment requires systemic antibiotics or antivirals, not inhaled corticosteroids
• Systemic corticosteroids may be used in severe cases of pneumonia with septic shock
• Caution is advised in viral CAP due to potential increased mortality with corticosteroid use
• Corticosteroid inhalers are not effective for pneumonia treatment and may worsen outcomes by suppressing local immune responses.

From the Research

Corticosteroid Inhalers for Pneumonia Treatment

• The use of corticosteroid inhalers as adjuvant therapy in community-acquired pneumonia has been explored in several studies 2, 3, 4, 5, 6.
• A narrative review published in 2020 discussed the potential benefits of inhaled corticosteroids in pneumonia, suggesting that they may provide therapeutic benefits directly to the lung with minimal systemic effects 2.
• A Cochrane review published in 2011 found weak evidence that corticosteroids did not significantly reduce mortality, but accelerated the resolution of symptoms and decreased the rate of relapse of the disease 3.
• A 2017 update of the Cochrane review found that corticosteroids significantly reduced mortality in adults with severe pneumonia, but not in adults with non-severe pneumonia 4.
• A systematic review and meta-analysis published in 2023 found that corticosteroids probably reduce mortality in more severe community-acquired pneumonia, with an optimal dose of approximately 6 mg of dexamethasone (or equivalent) for a duration of therapy of 7 days 6.

Benefits and Risks of Corticosteroid Inhalers

• The benefits of corticosteroid inhalers in pneumonia treatment include:
  • Reduced mortality in severe pneumonia 4, 6
  • Accelerated resolution of symptoms 3
  • Decreased rate of relapse of the disease 3
  • Reduced need for invasive mechanical ventilation 6
  • Reduced intensive care unit (ICU) admission 6
• The risks of corticosteroid inhalers in pneumonia treatment include:
  • Increased risk of hyperglycemia 4, 6
  • Potential for rebound phenomenon if the drug is not weaned slowly 5

Clinical Implications

• The use of corticosteroid inhalers in pneumonia treatment should be considered on a case-by-case basis, taking into account the severity of the disease and the potential benefits and risks 4, 5, 6.
• Further research is needed to establish the ideal timing, dose, route of delivery, duration, and patient selection for corticosteroid inhalers in pneumonia treatment 2, 6.