Abstract
Community-acquired pneumonia is still a major cause of morbidity and mortality worldwide. Since the inflammatory response induced by the immune system is often a major contributor to the lung injury, it becomes reasonable to assess the potential benefit of anti-inflammatory agents in treating community-acquired pneumonia. The role of corticosteroids as adjunct anti-inflammatory agents in treating community-acquired pneumonia is still controversial. Several studies have assessed the benefit of their use in patients with community-acquired pneumonia. In most of those studies, the route of corticosteroids administration was systemic. The aim of this article is to provide a concise review of the role of corticosteroids in treating community-acquired pneumonia when administered via inhalational route, with the potential benefit of avoiding systemic side effects of corticosteroids while exerting the same anti-inflammatory effects on the lungs. Conclusion: the use of inhaled corticosteroids may be of benefit in certain patient subsets with community-acquired pneumonia. Further randomized controlled trials are needed for better determination of such patient subsets.
Highlights
Lower respiratory infections are still amongst the top ten most common causes of death worldwide according to the World Health Organization (WHO) data [1]
In the USA, community-acquired pneumonia (CAP) has an estimated burden of more than 1.5 million annual adult hospitalizations, 10,000 deaths occurring during hospitalization, and around
In a meta-analysis published by Fine et al, the overall mortality of CAP ranged between 13.6% in hospitalized patients and 36.5% in patients admitted to the intensive care unit [4]
Summary
Lower respiratory infections are still amongst the top ten most common causes of death worldwide according to the World Health Organization (WHO) data [1]. In addition to the direct pathogen-mediated lung injury, the inflammatory response elicited by the immune system plays a role in the pathogenesis of CAP, making the utilization of antiinflammatory agents as an adjuvant therapy a considerable approach in treating CAP [7]. CAP represents a clinical syndrome in which acute infection of the lung(s) develops in patients who have not been hospitalized recently and have not been exposed to the health care system. Though an inadequate immune response can result in life-threatening infection, an excessive response can potentially lead to life-threatening inflammatory injury as well [7,11]. The alveolar-capillary barrier damage caused by the inflammatory mediators leads to protein-rich fluid influx into the alveoli causing noncardiogenic pulmonary edema, which is a defining characteristic of acute lung injury (ALI) [11,12]. The subsequent inappropriate accumulation of leukocytes and platelets, and the uncontrolled activation of coagulation pathways are important pathophysiologic concepts of ALI [13]
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