Corticosteroids in Acute Lung Injury: The Dilemma Continues

Abstract

Acute lung injury (ALI) represents a serious heterogenous pulmonary disorder with high mortality. Despite improved understanding of the pathophysiology, the efficacy of standard therapies such as lung-protective mechanical ventilation, prone positioning and administration of neuromuscular blocking agents is limited. Recent studies have shown some benefits of corticosteroids (CS). Prolonged use of CS can shorten duration of mechanical ventilation, duration of hospitalization or improve oxygenation, probably because of a wide spectrum of potentially desired actions including anti-inflammatory, antioxidant, pulmonary vasodilator and anti-oedematous effects. However, the results from experimental vs. clinical studies as well as among the clinical trials are often controversial, probably due to differences in the designs of the trials. Thus, before the use of CS in ARDS can be definitively confirmed or refused, the additional studies should be carried on to determine the most appropriate dosing, timing and choice of CS and to analyse the potential risks of CS administration in various groups of patients with ARDS.

Repurposing existing drugs for COVID-19: an endocrinology perspective

“…The only endocrine-related drug class that currently has evidence for COVID-19 are the glucocorticoids. Their use for severe illnesses has dubious and contradictory data [62,63], that seems to depend on the etiology and patterns of lung injury, level of severity, and level of contribution of an overreactive inflammatory response for the severe state, since the two major actions expected from glucocorticoids are their strong anti-inflammatory properties and as enhancers of the physiological response to stress. However, specifically for severe COVID-19, emerged data has been favorable for the use of glucocorticoids, since it has been demonstrated to reduce mortality among hospitalized patients, particularly those in mechanic ventilation [64], which corresponds to the third stage of COVID-19, and 10 currently ongoing clinical trials are testing glucocorticoids in this stage [65].…”

The effects and safety of omega-3 fatty for acute lung injury: a systematic review and meta-analysis

“…However, the mortality of ALI/ARDS is still high with a range of 40 to 31% [4,5]. In addition to infection control, low tidal volume protective lung mechanical ventilation and nutritional treatment of ARDS/ALI play an important role in the treatment strategies [6][7][8], especially the provision of calories by fat nutrition is a key part [9].…”

Senescence in Pulmonary Fibrosis: Between Aging and Exposure

“…Aberrant activation of the immune system has profound effects on disease outcome. To counter excess immune activation in pulmonary injury and fibrosis we adopted broad spectrum immunomodulation (corticosteroids, anti-cytokine antibodies) (169,170). However, its efficacy has been sporadic and a number of dilemmas remain, as to whether steroid immunomodulation is at all effective in toning down the activation of a senescent immune cell; or if the doses used to treat elderly individuals are adequate to address the myeloid lineage expansion typical of aging (171,172).…”