Table 2

Summary: corticosteroids in lung disease

Benefit?IndicationEffectEvidence strengthUnanswered questions
Embedded ImageSarcoidosisShort-term improved symptoms, chest imaging and pulmonary functionShort term: Strong
Long term: Weak
Long-term efficacy; dosage and duration
Embedded ImagePulmonary tuberculosisNo benefitStrongTB-infected ALI patients
Embedded ImagePneumcystis jiroveciiIn HIV-infected individuals, reduction in mortality rate and need for mech vent at 1 monthStrongRole in non-HIV infected individuals
Embedded ImageInfluenzaNo benefit, possible harm: increased risk of nosocomial infection, rate of ICU admit, and req. for mech ventModerateNo RCT on viral influenza with CS
Embedded ImageCommunity acquired pneumoniaImproved time to clinical stability, reduced hospital length of stay and req. for mech vent, reduced progression to ARDSModerate
Embedded ImageAcute hypersensitivity pneumonitisImproved FEV1, FVC, DLCO at 1 month that diminishes at 1 and 5 yearsWeak
Embedded ImageChronic hypersensitivity pneumonitisNo benefit in fibrotic phenotypeWeak
Embedded ImageAcute eosinophilic pneumoniaResolution of symptoms including respiratory failure, normalization of chest radiographs, lack of frequent recurrence, and minimal residual abnormalities on pulmonary function testingStrong
Embedded ImageChronic eosinophilic pneumoniaComplete response; relapse on cessation; improvement in restrictive abnormalities on pulmonary functionStrongCEP with coexisting asthma
Embedded ImageDesquamative interstitial pneumoniaEffective in mild/moderately fibrotic casesModerateConfounding with smoking cessation
Embedded ImageMicroscopic polyangiitis and granulomatosis with polyangiitisIn combination with cyclophosphamide, improved remission and mortality outcomesModerateEvidence for long-term use
Embedded ImageAsthmaImproved quality of life, decreased rate of acute exacerbations, and providing a protective effect against severe exacerbationsStrong
Embedded ImageChronic obstructive pulmonary diseaseControversial efficacy; more effective in combination with LABA and/or LAMA and in eosinophilic patientsStrong
Embedded ImageEosinophilic granulomatosis with polyangiitis (Churg Strauss Syndrome)Clinical remission in patients without poor prognostic factorsModerateDosage and duration; use in alveolar hemorrhage
Embedded ImageCOVID-19Reduced risk of death in severe COVID-19 induced ARDSStrongCombination therapies, use in non-life-threatening COVID-19
Embedded ImageSeasonal and pandemic influenzaIncreased risk of death, nosocomial infection, rate of ICU admit, mech ventWeakMissing RCT for viral influenza GCs
Embedded ImagePneumocystis jiroveciiReduced risk of death, vent dependenceStrong (HIV)
Weak (non-HIV)
Embedded ImageCommunity acquired pneumoniaImproving time to clinical stability, reducing hospital length of stay, need for mechanical ventilation, and progression to acute respiratory distress syndrome,ModerateControversial effect on mortality
Embedded ImageUsual interstitial pneumoniaNo benefitWeak
Embedded ImageIdiopathic pulmonary fibrosisPossible harm—reduced survivalStrongEffect of GCs in acute exacerbation of IPF
Embedded ImageConnective tissue disease–UIPRegularly used but weak evidenceWeakRare—only case studies, no differentiation between IPF-UIP and CTD-UIP
Embedded ImageCryptogenic organizing pneumoniaComplete response (generally with resolution of presenting symptoms and pulmonary opacities without leaving significant physiologic or imaging sequalae)ModerateDosage and duration unknown
Embedded ImageRespiratory bronchiolitis–Interstitial lung diseaseDecline in pulmonary function possibleWeakLack of studies—rare condition
Embedded ImageNon-specific interstitial pneumoniaBenefit to symptoms and radiographic movementWeakOptimal dosage
  • ARDS, acute respiratory distresss syndrome; CEP, chronic eosinophilic pneumonia; CS, corticosteroid; CTD-IUP, connective tissue disease–usual interstitial pneumonia; DLCO, diffusing capacity of the lungs for carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; GC, glucocorticoid; ICU, intensive care unit ; IPF, idiopathic pulmonary fibrosis; RCT, randomized controlled trial; TB, tuberculosis.