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A Prospective Study on Use of Corticosteroids Therapy in The Treatment of Lower Respiratory Tract Infections in Tertiary Care Hospital
Corresponding Author(s) : Shafia Farheen
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 13 No. 3 (2025): 2025 Volume -13 - Issue 3
Abstract
Introduction: Lower Respiratory Tract Infections are one of the major global health problems leading to high morbidity and mortality, especially in children, elderly and immune compromised persons. Lower respiratory tract infection is defined as infections of airway and lung structures within the area below the larynx, causing involvement of the trachea, bronchi, bronchioles, and alveoli. The clinical conditions of lower respiratory tract infections are most often caused by microorganisms such as Streptococcus pneumoniae and Haemophiles influenzae; viruses such as influenza and respiratory syncytial virus; and sometimes fungi. LRTIs comprise most of the common illnesses such as pneumonia, acute bronchitis, bronchiolitis, and sometimes exacerbations of chronic respiratory diseases like chronic obstructive pulmonary disease. Methodology: A prospective observational study involving analysis of inpatients and outpatients of pulmonology department diagnosed with pulmonary disease with other comorbid conditions, using patient data collection form for a study period of 6 months. Results: A 6 months study of 120 pulmonary disease patients (66 males, 54 females) found that corticosteroids therapy, particularly formoterol fumarate and hydrocortisone, was most frequently administered (87%). Bronchodilators (levo salbutamol and ipratropium bromide) antibiotics (sulbactam, cefoperazone and clarithromycin) and antacids (pantoprazole and magnesium oxide) were also commonly prescribed. Majority of patients had comorbid conditions like diabetes and hypertension with the age ranging between 51-70 years old. Conclusion: The study analyzed 120 pulmonary patients, shown high use of corticosteroid (87%). Corticosteroids found useful in reducing inflammation of Asthma and Chronic obstructive pulmonary disease, but required careful management due to side effects. Their widespread use highlights their importance, but future research should assess long-term outcomes and potential risks for better treatment strategies.
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- Liscynesky C. Lung abscesses and pleural abscesses. In: Cohen J, editor. Infectious Diseases. Vol 1. 2017:263 70.e1. DOI: 10.1016/B978 0 7020 6285 8.00030 7
- Feldman C. Epidemiology of lower respiratory tract infections in adults. Expert Rev Respir Med. 2019 Dec 24;13(1):63 77. pubmed.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov
- Rubinstein E, Carbon C, Rangaraj M, Santos JI, Thys J P, Veyssier P. Lower respiratory tract infections: etiology, current treatment, and experience with fluoroquinolones. Clin Microbiol Infect. 1998 Apr;4(Suppl 2):S42 50. DOI: 10.1111/j.1469 0691.1998.tb00693.x
- Claassen Weitz S, Lim KYL, Mullally C, Zar HJ, Nicol MP. The association between bacteria colonizing the upper respiratory tract and lower respiratory tract infection in young children: a systematic review and meta-analysis. Clin Microbiol Infect. 2021 Sep;27(9):1262 70.
- Bohte R, van Furth R, van den Broek PJ. Aetiology of community acquired pneumonia: a prospective study among adults requiring admission to hospital. Thorax. 1995 May;50(5):543 7. doi: 10.1136/thx.50.5.543
- Gaballa SA, Kompella UB, Elgarhy O, Alqahtani AM, Pierscionek B, Alany RG, Abdelkader H. Corticosteroids in ophthalmology: drug delivery innovations, pharmacology, clinical applications, and future perspectives. Drug Deliv Transl Res. 2020;11(3):866–893. Doi: 10.1007/s13346-020-00843-z
- Nakamoto T. Systemic corticosteroid as an adjunctive treatment for lower respiratory tract infection in children with severe motor and intellectual disabilities. J Infect Chemother. 2022 Mar;28(3):384–388.
- Lin KJ. Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study. PLoS Med. 2020 Mar 31;17(3).
- Hemamalini. Prescribing pattern of antibiotics in lower respiratory tract infection among children aged less than 5 years. Indian J Pharm Pharmacol. 2016;3(4):182–185.
- Badar V. Prescription pattern study of respiratory tract infections in paediatric indoor patients in a tertiary care teaching hospital – a prospective observational study. Asian J Pharm Clin Res. 2018 Jul;11(7).
- Yang X, Jin H. Safety of steroids in treatment of acute respiratory disease in children. Transl Pediatr. 2022 Feb;11(2):194–203. PubMedPMC.
- Vinaykumar N. Clinical profile of acute LRTI in children aged 2–60 months: An observational study. J Family Med Prim Care. 2020 Oct 30;9(10):5152–5157. doi: 10.4103/jfmpc.jfmpc_624_20
- Ieven M. Aetiology of LRTI in adults in primary care: a prospective study. Clin Microbiol Infect. 2018 Nov;24(11):1158–1163.
- Van Woensel JB. Dexamethasone for treatment of patients mechanically ventilated for LRTI. Thorax. 2003 May;58(5):383–387. doi: 10.1097/CCM.0b013e318218a030
- Hay AD. Effect of oral prednisolone on symptom duration and severity in non-asthmatic adults with acute LRTI: A randomized clinical trial. JAMA Network Open. 2017 Aug 22;318(8):721–730. JAMA NetworkPubMedBMJ.
- Huang J. Efficacy & safety of adjunctive corticosteroids therapy for patients with severe community-acquired pneumonia: A systematic review and meta-analysis. Crit Care. 2023 Jul 8;27(274). PubMedPMC.
- Muiser S. Understanding the role of long-acting muscarinic antagonists in asthma treatment. Ann Allergy Asthma Immunol. 2022 Apr;128(4):352–360.
- Dhand R. The role of nebulized therapy in the management of COPD: evidence and recommendations. J Chronic Obstruct Pulmon Dis. 2012 Jan 31;9(1):58–72.
- Poole PJ. Role of mucolytics in the management of COPD. Int J Chron Obstruct Pulmon Dis. 2006 Jun 15;1(2):123–128.
- Casey G. COPD: obstructed lungs. Nurs N Z. 2016 Jun;22(5):20–24.
- Yang IA, et al. Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2023 Mar 27;(3):CD002991.pub4.
- DOI: 10.1002/14651858.CD00299
- Spangler DL. The role of inhaled corticosteroids in asthma treatment: a health economic perspective. Am J Manag Care. 2012 Jan;18(2 Suppl):S35–9. ASH Publications+6PubMed+6PMC+6
- Malpica L. Practical approach to monitoring and prevention of infectious complications associated with systemic corticosteroids, antimetabolites, cyclosporine, and cyclophosphamide in nonmalignant hematologic diseases. Blood. 2020;2020(1):319–27.
- Blakey J, et al. Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand. Respirology. 2021 Dec;26(12):1112–30. DOI: 10.1111/resp.14147.
- Zhan WZ. Clinical characteristics and 2-year outcomes of chronic obstructive pulmonary disease patients with high blood eosinophil counts: a population-based prospective cohort study in China. Arch Bronconeumol. 2023 Jul;60(7):402–9.
- Kearns N, et al. Inhaled corticosteroids in acute asthma: A systematic review and meta-analysis. J Allergy Clin Immunol Pract. 2020 Feb;8(2):605–17.e6. Doi: 10.1016/j.jaip.2019.08.051. PubMed
- David B, Bafadhel M, Koenderman L, De Soyza A. Eosinophilic inflammation in COPD: from an inflammatory marker to a treatable trait. Thorax. 2021 Feb;76(2):188–195. doi: 10.1136/thoraxjnl-2020-215167
- O’Byrne P, Fabbri LM, Pavord ID, Papi A, Petruzzelli S, Lange P. Asthma progression and mortality: the role of inhaled corticosteroids. Eur Respir J. 2019 Jul 18;54(1):1900491. doi: 10.1183/13993003.00491-2019 PubMedOUCI
- Spangler DL. The role of inhaled corticosteroids in asthma treatment: a health economic perspective. Am J Manag Care. 2012 Jan;18(2 Suppl):S35–39. PubMed
- Malpica L. Practical approach to monitoring and prevention of infectious complications associated with systemic corticosteroids, antimetabolites, cyclosporine, and cyclophosphamide in nonmalignant hematologic diseases. Blood. 2020;2020(1):319–327. PubMedWiley Online Library
- Zhan WZ. Clinical characteristics and 2-year outcomes of chronic obstructive pulmonary disease patients with high blood eosinophil counts: a population-based prospective cohort study in China. Arch Bronconeumol. 2023 Jul;60(7):402–409.
- Rochat T. Pneumology. Inhaled corticosteroids in COPD: more and interesting data! Rev Med Suisse. 2008 Jan 16;4(140):155–157. PubMed+3PubMed+3PubMed+3Europe PMC+5PubMed+5PubMed+5
- Uwagboe I, Adcock IM, Lo Bello F, Caramori G, Mumby S. New drugs under development for COPD. Minerva Med. 2022 Jun;113(3):471–496. doi:10.23736/S0026-4806.22.08024-7. PubMed
- Fan VS, Bryson CL, Curtis JR, Fihn SD, Bridevaux PO, McDonell MB, Au DH. Inhaled corticosteroids in chronic obstructive pulmonary disease and risk of death and hospitalization: time-dependent analysis. Am J Respir Crit Care Med. 2003 Dec 15;168(12):1488–1494. doi: 10.1164/rccm.200301-019OC.
References
Liscynesky C. Lung abscesses and pleural abscesses. In: Cohen J, editor. Infectious Diseases. Vol 1. 2017:263 70.e1. DOI: 10.1016/B978 0 7020 6285 8.00030 7
Feldman C. Epidemiology of lower respiratory tract infections in adults. Expert Rev Respir Med. 2019 Dec 24;13(1):63 77. pubmed.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov
Rubinstein E, Carbon C, Rangaraj M, Santos JI, Thys J P, Veyssier P. Lower respiratory tract infections: etiology, current treatment, and experience with fluoroquinolones. Clin Microbiol Infect. 1998 Apr;4(Suppl 2):S42 50. DOI: 10.1111/j.1469 0691.1998.tb00693.x
Claassen Weitz S, Lim KYL, Mullally C, Zar HJ, Nicol MP. The association between bacteria colonizing the upper respiratory tract and lower respiratory tract infection in young children: a systematic review and meta-analysis. Clin Microbiol Infect. 2021 Sep;27(9):1262 70.
Bohte R, van Furth R, van den Broek PJ. Aetiology of community acquired pneumonia: a prospective study among adults requiring admission to hospital. Thorax. 1995 May;50(5):543 7. doi: 10.1136/thx.50.5.543
Gaballa SA, Kompella UB, Elgarhy O, Alqahtani AM, Pierscionek B, Alany RG, Abdelkader H. Corticosteroids in ophthalmology: drug delivery innovations, pharmacology, clinical applications, and future perspectives. Drug Deliv Transl Res. 2020;11(3):866–893. Doi: 10.1007/s13346-020-00843-z
Nakamoto T. Systemic corticosteroid as an adjunctive treatment for lower respiratory tract infection in children with severe motor and intellectual disabilities. J Infect Chemother. 2022 Mar;28(3):384–388.
Lin KJ. Prescribing systemic steroids for acute respiratory tract infections in United States outpatient settings: A nationwide population-based cohort study. PLoS Med. 2020 Mar 31;17(3).
Hemamalini. Prescribing pattern of antibiotics in lower respiratory tract infection among children aged less than 5 years. Indian J Pharm Pharmacol. 2016;3(4):182–185.
Badar V. Prescription pattern study of respiratory tract infections in paediatric indoor patients in a tertiary care teaching hospital – a prospective observational study. Asian J Pharm Clin Res. 2018 Jul;11(7).
Yang X, Jin H. Safety of steroids in treatment of acute respiratory disease in children. Transl Pediatr. 2022 Feb;11(2):194–203. PubMedPMC.
Vinaykumar N. Clinical profile of acute LRTI in children aged 2–60 months: An observational study. J Family Med Prim Care. 2020 Oct 30;9(10):5152–5157. doi: 10.4103/jfmpc.jfmpc_624_20
Ieven M. Aetiology of LRTI in adults in primary care: a prospective study. Clin Microbiol Infect. 2018 Nov;24(11):1158–1163.
Van Woensel JB. Dexamethasone for treatment of patients mechanically ventilated for LRTI. Thorax. 2003 May;58(5):383–387. doi: 10.1097/CCM.0b013e318218a030
Hay AD. Effect of oral prednisolone on symptom duration and severity in non-asthmatic adults with acute LRTI: A randomized clinical trial. JAMA Network Open. 2017 Aug 22;318(8):721–730. JAMA NetworkPubMedBMJ.
Huang J. Efficacy & safety of adjunctive corticosteroids therapy for patients with severe community-acquired pneumonia: A systematic review and meta-analysis. Crit Care. 2023 Jul 8;27(274). PubMedPMC.
Muiser S. Understanding the role of long-acting muscarinic antagonists in asthma treatment. Ann Allergy Asthma Immunol. 2022 Apr;128(4):352–360.
Dhand R. The role of nebulized therapy in the management of COPD: evidence and recommendations. J Chronic Obstruct Pulmon Dis. 2012 Jan 31;9(1):58–72.
Poole PJ. Role of mucolytics in the management of COPD. Int J Chron Obstruct Pulmon Dis. 2006 Jun 15;1(2):123–128.
Casey G. COPD: obstructed lungs. Nurs N Z. 2016 Jun;22(5):20–24.
Yang IA, et al. Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2023 Mar 27;(3):CD002991.pub4.
DOI: 10.1002/14651858.CD00299
Spangler DL. The role of inhaled corticosteroids in asthma treatment: a health economic perspective. Am J Manag Care. 2012 Jan;18(2 Suppl):S35–9. ASH Publications+6PubMed+6PMC+6
Malpica L. Practical approach to monitoring and prevention of infectious complications associated with systemic corticosteroids, antimetabolites, cyclosporine, and cyclophosphamide in nonmalignant hematologic diseases. Blood. 2020;2020(1):319–27.
Blakey J, et al. Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand. Respirology. 2021 Dec;26(12):1112–30. DOI: 10.1111/resp.14147.
Zhan WZ. Clinical characteristics and 2-year outcomes of chronic obstructive pulmonary disease patients with high blood eosinophil counts: a population-based prospective cohort study in China. Arch Bronconeumol. 2023 Jul;60(7):402–9.
Kearns N, et al. Inhaled corticosteroids in acute asthma: A systematic review and meta-analysis. J Allergy Clin Immunol Pract. 2020 Feb;8(2):605–17.e6. Doi: 10.1016/j.jaip.2019.08.051. PubMed
David B, Bafadhel M, Koenderman L, De Soyza A. Eosinophilic inflammation in COPD: from an inflammatory marker to a treatable trait. Thorax. 2021 Feb;76(2):188–195. doi: 10.1136/thoraxjnl-2020-215167
O’Byrne P, Fabbri LM, Pavord ID, Papi A, Petruzzelli S, Lange P. Asthma progression and mortality: the role of inhaled corticosteroids. Eur Respir J. 2019 Jul 18;54(1):1900491. doi: 10.1183/13993003.00491-2019 PubMedOUCI
Spangler DL. The role of inhaled corticosteroids in asthma treatment: a health economic perspective. Am J Manag Care. 2012 Jan;18(2 Suppl):S35–39. PubMed
Malpica L. Practical approach to monitoring and prevention of infectious complications associated with systemic corticosteroids, antimetabolites, cyclosporine, and cyclophosphamide in nonmalignant hematologic diseases. Blood. 2020;2020(1):319–327. PubMedWiley Online Library
Zhan WZ. Clinical characteristics and 2-year outcomes of chronic obstructive pulmonary disease patients with high blood eosinophil counts: a population-based prospective cohort study in China. Arch Bronconeumol. 2023 Jul;60(7):402–409.
Rochat T. Pneumology. Inhaled corticosteroids in COPD: more and interesting data! Rev Med Suisse. 2008 Jan 16;4(140):155–157. PubMed+3PubMed+3PubMed+3Europe PMC+5PubMed+5PubMed+5
Uwagboe I, Adcock IM, Lo Bello F, Caramori G, Mumby S. New drugs under development for COPD. Minerva Med. 2022 Jun;113(3):471–496. doi:10.23736/S0026-4806.22.08024-7. PubMed
Fan VS, Bryson CL, Curtis JR, Fihn SD, Bridevaux PO, McDonell MB, Au DH. Inhaled corticosteroids in chronic obstructive pulmonary disease and risk of death and hospitalization: time-dependent analysis. Am J Respir Crit Care Med. 2003 Dec 15;168(12):1488–1494. doi: 10.1164/rccm.200301-019OC.