Associated inflammatory response in pneumonia: role of adjunctive therapy with glucocorticoids.
OBJECTIVE
This article reviews the potential use of glucocorticoids as adjunctive therapy in the management of patients with severe bacterial pneumonia or pulmonary infections of other etiologies.


RESULTS
The importance of an adequate assessment of the inflammatory process and the appearance of inflammatory markers that correlate with the severity of pneumonia is underlined. A recent randomized clinical trial indicates that adjunctive treatment of severe community-acquired pneumonia with glucocorticoids reduces complications and improves survival. The role of glucocorticoids in other lung infections is also reviewed. The design of new compounds with similar anti-inflammatory properties to classical glucocorticoids but with significantly fewer side effects constitutes a specific challenge for the near future.


CONCLUSIONS
Although adjunctive treatment with glucocorticoids in severe pneumonia is probably indicated, further randomized clinical trials are urgently needed to confirm the preliminary positive results. In this regard, a proper evaluation of the inflammatory response is likely to be essential for the accurate selection of the target population.
Rañó
Ana
A
Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clínic, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Villaroel 170, 08036 Barcelona, Spain.
Agustí
Carlos
C
Sibila
Oriol
O
Torres
Antoni
A
D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000276:immunology; D008171:Lung Diseases / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology
D005938:Glucocorticoids