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.