Corticosteroids, COVID-19 pneumonia, and acute respiratory distress syndrome
Michael A. Matthay, Katherine D. Wick
Abstract
The effects of corticosteroids in the treatment of viral pneumonia and the acute respiratory distress syndrome (ARDS) have been the subject of controversy over decades, including several studies through the last 15 years. The majority of studies report a detrimental effect of corticosteroids for the treatment of influenza viral pneumonia, including studies during the H1N1 influenza outbreak of 2009-2010 (1, 2) and subsequent studies with H5N1 influenza pneumonia (3). Most studies were retrospective, though the analyses were adjusted for baseline differences between the corticosteroid-treated and untreated patients (4). During the 2003 severe acute respiratory syndrome (SARS) coronavirus outbreak, one retrospective study found evidence of benefit among patients with ARDS from SARS (5). Others showed either no benefit or evidence of harm (6). Notably, viral RNA clearance was delayed in patients who received early corticosteroids (7). In a retrospective study of corticosteroids in critically ill patients with Middle East respiratory syndrome, unadjusted mortality was higher among patients who received corticosteroids, and RNA viral clearance was delayed (8). Thus, the potential beneficial or harmful effect of corticosteroids in patients with SARS-coronavirus 2 (SARS-CoV-2) has been an area of major interest since the onset of the coronavirus disease 2019 (COVID-19) pandemic.