4.3 Review

Glucocorticoid therapy in respiratory illness: bench to bedside

Journal

JOURNAL OF INVESTIGATIVE MEDICINE
Volume 70, Issue 8, Pages 1662-1680

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1136/jim-2021-002161

Keywords

anti-inflammatory agents; respiratory system; glucocorticoids; lung diseases; critical care

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This article presents a comprehensive review of the use of immune-modulating corticosteroids (CSs) in respiratory diseases. Although CSs play a critical role in the management of respiratory illnesses, their benefits depend on the underlying pathology and specific risks for each patient.
Each year, hundreds of millions of individuals are affected by respiratory disease leading to approximately 4 million deaths. Most respiratory pathologies involve substantially dysregulated immune processes that either fail to resolve the underlying process or actively exacerbate the disease. Therefore, clinicians have long considered immune-modulating corticosteroids (CSs), particularly glucocorticoids (GCs), as a critical tool for management of a wide spectrum of respiratory conditions. However, the complex interplay between effectiveness, risks and side effects can lead to different results, depending on the disease in consideration. In this comprehensive review, we present a summary of the bench and the bedside evidence regarding GC treatment in a spectrum of respiratory illnesses. We first describe here the experimental evidence of GC effects in the distal airways and/or parenchyma, both in vitro and in disease-specific animal studies, then we evaluate the recent clinical evidence regarding GC treatment in over 20 respiratory pathologies. Overall, CS remain a critical tool in the management of respiratory illness, but their benefits are dependent on the underlying pathology and should be weighed against patient-specific risks.

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