Influence of glucocorticoids on markers of inflammation in community-acquired pneumonia ECE2015 17th European Congress of Endocrinology

In addition, complains Welte, many of the studies included patients with a good prognosis of CAP, making an additional steroid treatment “more questionable”. Despite the large number of cases, there were few investigations included in our analysis and all were retrospective in nature. Moreover, there was evidence for treatment selection bias in these investigations that was not adjusted in the original analysis and could not be adjusted for in our meta-analysis. We also caution that differences in definitions of mortality may further have introduced bias.

  • The current 2014 NICE guideline on pneumonia does not recommend routinely offering a corticosteroid to patients with community‑acquired pneumonia unless they have other conditions for which this treatment is indicated.
  • None of the studies focusing on corticosteroid treatment in CAP, including those in Siemieniuk’s review, have a strong outcome parameter such as mortality, argues Welte.
  • We also caution that differences in definitions of mortality may further have introduced bias.
  • For example, if you have an upset stomach after taking steroids, your GP may suggest taking the tablet with meals or after food.
  • Also, talk to them about whether you need to carry a steroid card.

Evidence does not support increasing ICS in children in asthma to improve asthma attack outcomes. The results suggest that steroids are not effective in the treatment of chest infections in non-asthmatic adult patients. A 2011 systematic review of six small trials found that adding corticosteroid treatment increased speed of recovery slightly, but the evidence was not strong. The current review aimed to update the evidence on benefits and potential side effects of add-on corticosteroid treatment for people who had been admitted to hospital with pneumonia.


Clinicians should continue to follow appropriate clinical guidelines, such as the BTS guidelines for the management of community-acquired pneumonia in adults, summarised in MeReC Rapid Review No. 674. This is a card which lets healthcare professionals and emergency workers know you are prescribed a steroid and has the details of your medicine and dose. Before changing practice further trials would be helpful, to see if it is possible to replicate the findings and to clarify which corticosteroid to use, at what dose, and for whom. A more thorough assessment of potential adverse events, in people at higher risk of diabetes for example, would also help to quantify the potential downsides of a change in practice.

  • This lets healthcare professionals know you’re taking steroids.
  • Steroids can be taken in a number of ways for many different types of arthritis and related conditions, as shown in the table below.
  • To ensure the most up-to-date guidance is used it must be accessed directly from the CCG website and not saved or printed.
  • There was an absolute reduction in deaths of 5.6%, which was statistically significant.
  • You may be sent for an X-ray of your chest and blood tests to check for other conditions.

None of the studies focusing on corticosteroid treatment in CAP, including those in Siemieniuk’s review, have a strong outcome parameter such as mortality, argues Welte. “They all use surrogates, such as length of stay in hospital or time to reach clinical stability. If you’re taking steroid tablets you might need to avoid live vaccines, such as yellow fever.

The TORCH study

Although small amounts of steroids could pass into breast milk, there’s no research that has shown that it’s harmful to your baby, so guidelines say that people can breastfeed while taking steroid tablets. You should discuss the risks with your doctor if you have any concerns. Steroids can sometimes affect diabetes, high blood pressure or epilepsy, so you’ll have your blood pressure and blood sugar levels checked from time to time.

You might be given a small dose, known as a maintenance dose, for a long time to make sure your symptoms don’t return. You will be given the lowest possible dose for the shortest possible time, to reduce the risk of side effects. Your dose will probably be reduced gradually as your symptoms improve, or your doctor might suggest a weaker medication.

What are steroids?

Very strong topical steroids aren’t usually prescribed during pregnancy and breastfeeding. If you have indigestion or other stomach problems after starting steroids, then alcohol is likely to add to the problem, so you may want to cut back on how much alcohol you drink. If you’re having an operation, you might need to stop your steroids.

Steroid inhalers

Corticosteroids, often known as steroids, are an anti-inflammatory medicine. Pneumonia is usually treated with antibiotics and supplemental oxygen if the illness is severe. Vaccines are available against the most common infectious cause, Streptococcus pneumoniae, also flu vaccine helps by protecting against one of the predisposing conditions.

If you have had several
courses of steroid tablets or have been put on them for a longer period of time, speak with your doctor or healthcare professional about what you can do to reduce the chance of getting these side effects. Always get your medicines reviewed regularly so your doctor can make sure you’re on the right dose for you. There’s some evidence that steroid inhalers used by people with chronic obstructive pulmonary disease (COPD) can increase the risk of chest infections like pneumonia.

For adults admitted to hospital with severe pneumonia, this review found that adding corticosteroids to the usual antibiotic treatment may be beneficial. The evidence was less supportive of using corticosteroids in people with less severe pneumonia. Results showed modest benefits in allowing patients to reach a clinically stable recovery and leave hospital an average of one day earlier. Reduced need for artificial breathing support was the main benefit for people with non-severe pneumonia.

Information about steroid injections is covered on a different page. In some conditions, such as rheumatoid arthritis, the immune system produces inflammation in the joints or other parts of the body by mistake, which can cause permanent damage if left untreated. They’re also known as corticosteroids, and are different to anabolic steroids used by bodybuilders and athletes. If you have asthma and need two or more short courses in a year, or your symptoms keep coming back once you’ve finished the course, you should ask your GP for a referral to a specialist clinic.

Guidelines for non-HIV PCP (NH-PCP) recommend adjunctive corticosteroids based on expert opinion. We conducted a systematic review and meta-analysis characterizing adjunctive corticosteroids for NH-PCP. Giving doses of the steroid hydrocortisone to patients with severe pneumonia cut the risk of death by about half, according to a study released Tuesday. In the study, researchers funded by the French Ministry of Health randomly assigned 800 patients who had been placed in the intensive care unit to receive either hydrocortisone or a placebo.

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