Abstract
Steroids (corticosteroids) are anti-inflammatory drugs. Corticosteroids are used in many pulmonary conditions. Corticosteroids have a proven beneficial role in asthma, croup (Laryngotracheobronchitis), decreasing the risk and severity of respiratory distress syndrome (RDS), allergic bronchopulmonary aspergillosis, interstitial lung disease, hemangioma of trachea, Pulmonary eosinophillic disorders. Role of corticosteroids is controversial in many conditions e.g. idiopathic pulmonary hemosiderosis, bronchiolitis, hypersensitivity pneumonitis, hyperplasia of thymus, bronchiolitis, acute respiratory distress syndrome, aspiration syndromes, atypical pneumonias, laryngeal diphtheria, AIDS, SARS, sarcoidosis, meconium aspiration syndrome (MAS), pulmonary haemorrhage, bronchitis, bronchiolitis obliterans with organizing pneumonia in JRA, histiocytosis, á-1 antitrypsin deficiency, bordtella pertusis, pulmonary involvement in histiocytosis. However these are used empirically in many of these conditions despite lack of clear evidence in favour. There is concern about their side effects, especially on growth. Systemic steroids are associated with significant adverse effects. Pulmonary conditions have a strategic advantage that inhaled corticosteroids are useful in many of these. Although inhaled preparations of corticosteroids have been developed to maximise effective treatment of lung diseases characterised by inflammation and reduce the frequency of harmful effects, these have not been eliminated. There are situations where only systemic steroids are useful. Clinicians must weigh the benefits against the potential detrimental effects. It is recommended that standard protocols for use of steroids available in literature should be followed, always keeping a watch on the potential hazards of prolonged use.
Article PDF
Similar content being viewed by others
References
Wapner RJ, Sorokin Y, Thom EA et al. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynae 2006; 195: 633–642.
Crowther CA, Haslam RR, hiller JE et al. Neonatal RDS after repeat exposureof antenatal corticosteroids: a randomized controlled trial. Lancet 2006; 367: 1913–1919.
Halliday HL, Ehrenkranz RA, Doyle LW. Delayed (>3 weeks) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD001145. DOI: 10.1002/14651858.CD001145.
Doyale JW, Davis PG, Morley CJ et al. Low dose dexamethasone facilitates extubation among chronically ventilator dependent infants: a multicenter, international, randomize, control trial. Pediatrics 2006; 117: 75–83.
O’shea TM, Washburn LK, Nixon PA et al. Follow up of a randomized, placebo controlled trial of dexamethasone to decrease the duration of ventilator dependency in very low birth weight infants: neurodevelopmental outcomes at 4 to 11 years of age. Pediatrics 2007; 120: 594–602.
Andre P, Theobaud B, vre MH et al. Mtethylprednisolone, an alternative to dexamethasone in very premature infants at risk of CLD. Intensive Care Medicine 2000; 26: 1496–500.
Watterberg KL, Gerdes GS, Cole GS et al. Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia; a multicenteric trial. Pediatrics 2004; 114: 1649–1657.
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2007.
Edmonds ML, Camargo CA Jr, Brenner BE, Rowe BH. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002316. DOI: 10.1002/14651858.CD002316
Russell K, Wiebe N, Saenz A, Ausejo Segura M, Johnson D, Hartling L, Klassen TP. Glucocorticoids for croup. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001955. DOI: 10.1002/14651858.CD001955.pub2.
Patel H, Platt R, Lozano JM, Wang EEL. Glucocorticoids for acute viral bronchiolitis, in infants and young children. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004878. DOI: 10.1002/14651858.CD004878.
Blom D, Ermers M, Bont L, van Aalderen WMC, van Woensel JBM. Inhaled corticosteroids during acute bronchiolitis in the prevention of post-bronchiolitic wheezing. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004881. DOI: 10.1002/14651858. CD004881.pub2.
Jamaree Teeratakulpisaran, Limwattananon C, Tanupattarachai S et al. Efficacy of Dexamethasone injection for acute bronchiolitis in Hospitalized children. Ped Pulmonol 2007; 42: 433–439.
Corneli HM, Joseph J Zorc, Mahajan P et al. A multicenter, randomized, controlled trial of dexamethasone, for bronchiolitis. N Eng J Med 2007; 357: 331–339.
American Thoracic Society/European Respiratory Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. Am J Respir Crit Care Med 2000; 161: 646–664.
Paramothayan NS, Lasserson TJ, Jones PW. Corticosteroids for pulmonary sarcoidosis. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001114. DOI: 10.1002/14651858.CD001114.pub2.
Choy EHS, Hoogendijk JE, Lecky B, Winer JB. Immunosuppressant and immunomodulatory treatment, for dermatomyositis and polymyositis. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003643. DOI: 10.1002/14651858.CD003643.pub2
Kabra SK, Bhargava S, Lodha R, Satyavani A, Walia M. Idiopathic pulmonary hemosiderosis: clinical profile and follow up of 26 children. Indian Pediatr 2007; 44: 333–338.
Cheng K, Ashby D, Smyth R. Oral steroids for cystic fibrosis. Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD000407. DOI: 10.1002/14651858.CD000407.
Balfour-Lynn I, Walters S, Dezateux C. Inhaled corticosteroids for cystic fibrosis. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD001915. DOI: 10.1002/14651858.CD001915.
Ian M, Balfour-Lynn, Belinda Lees et al. Multicenter randomized controlled trial of withdrawal of inhaled corticosteroids in cystic fibrosis. Am J Respir Crit Care Med 2006; 173: 1356–1362.
Wark PA, Gibson PG, Wilson AJ. Azoles for ABPA associated with asthma. Cochrane Database Syst Rev 2004:CD001108
Tokunaga N, Ichikawa Y, Kuboshiro M, Higashi T, Fujino K, Kaji M. A case of miliary tuberculosis associated with acute respiratory failure during corticosteroid treatment of rheumatoid arthritis. Kekkaku, 1990; 65: 539.
Mansour AA, Al-Rbeay TB. Adjunct therapy with corticosteroids or paracentesis for treatment of tuberculous pleural effusion. East Mediterr Health J 2006; 12: 504–508.
Pope E, Krafchik BR, Macarthur C et al. Oral versus high dose pulse corticosteroids for problematic infantile hemangiomas: A randomized controlled trial. Pediatrics 2007; 119: e1239–e1247.
Lasserson TJ, Holt K, Milan SJ, Greenstone M. Oral steroids for bronchiectasis (stable and acute exacerbations). Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD002162. DOI: 10.1002/14651858.CD002162
A Peroianni, Ceccarelli D, Conti V et al. Aspiration pneumonia. Pathophysiological aspects, prevention and management. A review. Panminerva Med 2006; 48: 231–239.
Ward M, Sinn J. Steroid therapy for meconium aspiration syndrome in newborn infants. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003485. DOI: 10.1002/14651858.CD003485.
Havaldar PG. Dexamethazone in laryngeal diphteritic croup. Ann Troup Pediatrics 1997; 17: 21–23.
Campbel C, Jacob P. Deflazocort treatment of DMD. A systemic review. BMC Neurol 2003; 3: 7
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sethi, G., Singhal, K.K. Pulmonary Diseases and Corticosteroids. Indian J Pediatr 75, 1045–1056 (2008). https://doi.org/10.1007/s12098-008-0209-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-008-0209-0