Corticosteroids such as cortisone, hydrocortisone, and prednisone are used to treat many different lung conditions. They are also used to treat other conditions like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
These drugs act by decreasing inflammation as they mimic the effects of hormones produced by the adrenal glands and suppress the immune system. The adrenal glands are located on top of each kidney and produce hormones that help regulate metabolism, immune response, and blood pressure.
There’s a risk of side effects with corticosteroid treatment, depending on the dose taken and on the route of administration. Some may cause serious health problems and their use requires close monitoring.
Some side effects of oral corticosteroids include elevated pressure in the eyes (glaucoma), fluid retention, high blood pressure, psychological effects, and weight gain with fat deposits in the abdomen, face, and back of the neck.
Inhaled corticosteroids may cause oral thrush and hoarseness, as some of the drug may end up in the mouth and throat instead of the lungs.
Topical corticosteroids can lead to thin skin, red skin lesions, and acne. Injected corticosteroids may cause temporary side effects near the site of injection, such as thin skin, loss of color in the skin, facial flushing, insomnia, and high blood sugar.
Current use of corticosteroids in PF
In the past, doctors considered immune suppression to be important for the treatment of pulmonary fibrosis. Corticosteroids were typically used in addition to azathioprine or cyclophosphamide, both immune system suppressants. Later, N-acetylcysteine, a mucolytic (which reduces the thickness of mucus secretions in the lungs) was also added to the treatment regime.
However, many studies investigating the potential benefits of using the combination of corticosteroids, immunosuppressants and mucolytics had to be stopped early due to their clear negative effects in different patient groups.
As a result, the American Thoracic Society does not currently recommend the use of a combination of N-acetylcysteine, azathioprine, and prednisone in people with PF. Instead, a close case-by-case approach between the patient and the doctor is recommended to assess the potential harm and benefits of the treatment.
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