SoluMedrol in pneumonia pts?

[OKparamurse]

So I was talking with a coworker today about the indications for when and when not to use SoluMedrol. The obvious were stated - asthma, emphysema, COPD. But we came to a split when it came to pneumonia. From my understanding SoluMedrol is an intermediate-acting corticosteroid used to reduce inflammation, which obviously is desired in an inflammatory disease process. However, pneumonia from what I know is an infection with the dypsnea being caused by mucus buildup in the lungs; an issue SoluMedrol wouldn't help with. Could someone clarify with some reasoning for me? Thanks guys!

 

[NomadicMedic]

I asked a doc about this a while back and he said that there was concern of rebound inflammation following a high dose of steroids.

I think if you're treating a patient with dyspena and a suspicion of COPD/reactive airway issues that may benefit from steroids, you wouldn't be wrong with a dose of solu-medrol. I know that low dose pred is common.

However, in the case of confirmed pneumonia, I'd focus on fluid and maybe a Neb.

Maybe @ERDoc can weigh in?

 

[Tigger]

Is the immune suppression caused by steroids enough to be a consideration in pneumonia patients?

 

[teedubbyaw]

Good question. I did not give it to the last COPD guy I had with respiratory distress brought on my pneumonia. He was in his 80's and not in good health. I felt it wasn't beneficial to his outcome. Information on the subject seemed to lack.

 

[ERDoc]

Classically speaking, steroids reduce the immune system's ability to fight infection. However, the evidence seems to be pointing the other way. I don't think too many people here have access to Annals of Internal Medicine so here is a webmd synopsis of a recent meta-analysis (don't worry, it's not cancer). Further study is needed to confirm the results but it looks promising.

http://www.webmd.com/lung/news/20150810/steroids-may-help-speed-pneumonia-recovery-study-finds

 

[medicsb]

My concern used to be with giving a steroid to the pt. withouth a COPD/asthma Hx who is wheezing and suspected to have pneumonia. I posed the question to multiple docs and none had a good answer, and I don't recall ever finding a good answer when perusing pubmed or texts. Now as a doc (though a resident), I don't really have a great answer. The link posted by ERDoc makes me feel better about doing this; I'll have to look up the study as I had not heard of it. Realistically, even though steroids can suppress the immune system, they are often given along with antibiotics. There are many infectious processes where steroid are routinely given or may be indicated depending on severity - e.g. bacteria meningitis, PCP pneumonia (which occurs due to a suppressed immune system to begin with), ARDS (infection being one of many causes).

Without having read the above study, my though process is that as long as the infection is being treated, steroids would be expected to provide help if they're wheezing or have other signs of obstruction.

 

[johnrsemt]

My dad spent 5 days in the hospital (got out last Monday) for his first ever pneumonia (84 years old, Lucky man): They gave him Solumedrol IV and he is now on Prednisone orally. It has helped with his breathing but made his left leg swell enough that they sent him for an Ultrasound, worried about DVT.

 

[Doczilla]

See, that's the slippery slope with infections and steroids. In some cases, steroids coadministered with antibiotics are HIGHLY recommended as soon as possible, (meningitis) even before ancillary testing or spinal taps are performed.

As with any respiratory illness, we focus on

-Inflammation
- Secretions
- Bronchospasm

So with pneumonia, when we go down the list, we're able to tackle one of those at best. We can't really deal with the secretions, because unlike asthma and COPD, we can't dry up purulent exude with inhaled anticholinergics like we can with mucus.

I guess the question is, without simultaneously treating the infection (and thus the inflammatory byproducts of the war being waged at the cellular level), how much are we really helping them with that low dose of solumedrol?