Table 2
Summary: corticosteroids in lung disease
| Benefit? | Indication | Effect | Evidence strength | Unanswered questions |
| Sarcoidosis | Short-term improved symptoms, chest imaging and pulmonary function | Short term: Strong Long term: Weak | Long-term efficacy; dosage and duration |
| Pulmonary tuberculosis | No benefit | Strong | TB-infected ALI patients |
| Pneumcystis jirovecii | In HIV-infected individuals, reduction in mortality rate and need for mech vent at 1 month | Strong | Role in non-HIV infected individuals |
| Influenza | No benefit, possible harm: increased risk of nosocomial infection, rate of ICU admit, and req. for mech vent | Moderate | No RCT on viral influenza with CS |
| Community acquired pneumonia | Improved time to clinical stability, reduced hospital length of stay and req. for mech vent, reduced progression to ARDS | Moderate | |
| Acute hypersensitivity pneumonitis | Improved FEV1, FVC, DLCO at 1 month that diminishes at 1 and 5 years | Weak | |
| Chronic hypersensitivity pneumonitis | No benefit in fibrotic phenotype | Weak | |
| Acute eosinophilic pneumonia | Resolution of symptoms including respiratory failure, normalization of chest radiographs, lack of frequent recurrence, and minimal residual abnormalities on pulmonary function testing | Strong | |
| Chronic eosinophilic pneumonia | Complete response; relapse on cessation; improvement in restrictive abnormalities on pulmonary function | Strong | CEP with coexisting asthma |
| Desquamative interstitial pneumonia | Effective in mild/moderately fibrotic cases | Moderate | Confounding with smoking cessation |
| Microscopic polyangiitis and granulomatosis with polyangiitis | In combination with cyclophosphamide, improved remission and mortality outcomes | Moderate | Evidence for long-term use |
| Asthma | Improved quality of life, decreased rate of acute exacerbations, and providing a protective effect against severe exacerbations | Strong | |
| Chronic obstructive pulmonary disease | Controversial efficacy; more effective in combination with LABA and/or LAMA and in eosinophilic patients | Strong | |
| Eosinophilic granulomatosis with polyangiitis (Churg Strauss Syndrome) | Clinical remission in patients without poor prognostic factors | Moderate | Dosage and duration; use in alveolar hemorrhage |
| COVID-19 | Reduced risk of death in severe COVID-19 induced ARDS | Strong | Combination therapies, use in non-life-threatening COVID-19 |
| Seasonal and pandemic influenza | Increased risk of death, nosocomial infection, rate of ICU admit, mech vent | Weak | Missing RCT for viral influenza GCs |
| Pneumocystis jirovecii | Reduced risk of death, vent dependence | Strong (HIV) Weak (non-HIV) | |
| Community acquired pneumonia | Improving time to clinical stability, reducing hospital length of stay, need for mechanical ventilation, and progression to acute respiratory distress syndrome, | Moderate | Controversial effect on mortality |
| Usual interstitial pneumonia | No benefit | Weak | |
| Idiopathic pulmonary fibrosis | Possible harm—reduced survival | Strong | Effect of GCs in acute exacerbation of IPF |
| Connective tissue disease–UIP | Regularly used but weak evidence | Weak | Rare—only case studies, no differentiation between IPF-UIP and CTD-UIP |
| Cryptogenic organizing pneumonia | Complete response (generally with resolution of presenting symptoms and pulmonary opacities without leaving significant physiologic or imaging sequalae) | Moderate | Dosage and duration unknown |
| Respiratory bronchiolitis–Interstitial lung disease | Decline in pulmonary function possible | Weak | Lack of studies—rare condition |
| Non-specific interstitial pneumonia | Benefit to symptoms and radiographic movement | Weak | Optimal dosage |
ARDS, acute respiratory distresss syndrome; CEP, chronic eosinophilic pneumonia; CS, corticosteroid; CTD-IUP, connective tissue disease–usual interstitial pneumonia; DLCO, diffusing capacity of the lungs for carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; GC, glucocorticoid; ICU, intensive care unit ; IPF, idiopathic pulmonary fibrosis; RCT, randomized controlled trial; TB, tuberculosis.