Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread globally, becoming a huge public health challenge. Even though the vast majority of patients are asymptomatic, some patients present with pneumonia, acute respiratory distress syndrome (ARDS), septic shock, and death. It has been shown in several studies that the severity and clinical outcomes are related to dysregulated antiviral immunity and enhanced and persistent systemic inflammation. Corticosteroids have been used for the treatment of COVID-19 patients, as they are reported to elicit benefits by reducing lung inflammation and inflammation-induced lung injury. Dexamethasone has gained a major role in the therapeutic algorithm of patients with COVID-19 pneumonia requiring supplemental oxygen or on mechanical ventilation. Its wide anti-inflammatory action seems to form the basis for its beneficial action, taming the overwhelming “cytokine storm”. Amid a plethora of scientific research on therapeutic options for COVID-19, there are still unanswered questions about the right timing, right dosing, and right duration of the corticosteroid treatment. The aim of this review article was to summarize the data on the dexamethasone treatment in COVID-19 and outline the clinical considerations of corticosteroid therapy in these patients.
Highlights
Corticosteroids are known to temper down the host inflammatory response in the lungs, which may lead to acute lung injury and acute respiratory distress syndrome (ARDS) [52]
This theory was not confirmed in the study of Fang et al [51], who used a low dose of corticosteroids in patients with COVID-19; there was no significant difference in the duration of viral shedding between patients receiving and patients not receiving corticosteroids, irrespective of the severity of the disease
Dexamethasone has gained a major role in the therapeutic algorithm of patients with COVID-19 pneumonia requiring supplemental oxygen or on mechanical ventilation
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread around the world since its first appearance in China [1,2,3]. In the first pandemic wave, corticosteroids were introduced in the treatment of critically ill COVID-19 patients with respiratory failure in low-tomoderate doses and for short courses [4,11,12,13]. Guidelines and the World Health Organization (WHO) approved the findings on the beneficial use of dexamethasone in treating critically ill patients with COVID-19 and recommended the dexamethasone treatment in hospitalized patients with respiratory failure requiring a noninvasive/high-flow oxygen device or invasive ventilation [17]. The clinical benefit of this treatment in COVID-19 patients still remains controversial
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