Corticosteroid use in respiratory viral infections — friend or foe?

Abstract

Synthetic corticosteroids are among the most widely prescribed anti-inflammatory and immunosuppressive drugs available. In the treatment of respiratory diseases, inhaled corticosteroids, such as dexamethasone and prednisolone, have their indicated uses in the treatment or management of asthma and chronic obstructive pulmonary disease (COPD). However, the molecular mechanisms that underlie corticosteroid's immunoregulatory effects trail well behind its documented clinical efficacy. In support of this, the recent use of corticosteroids to treat inflammation associated with respiratory viral infections, for example, influenza, respiratory syncytial virus, and COVID-19, has emerged as an attractive albeit controversial choice. Here, we provide current opinions on the benefits and risks of using synthetic corticosteroids in respiratory viral infections, which may offer insight into their use to address future respiratory-related health problems.