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Original Research: OBSTRUCTIVE LUNG DISEASES |

The Effect of Steroid Use in Hospitalized Adults With Respiratory Syncytial Virus-Related IllnessSteroids and Respiratory Syncytial Virus

F. Eun-Hyung Lee, MD; Edward E. Walsh, MD; Ann R. Falsey, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Lee), Division of Infectious Diseases (Drs Walsh and Falsey), University of Rochester School of Medicine and Dentistry (Drs Lee, Walsh, and Falsey); and the Department of Medicine (Drs Walsh and Falsey), Rochester General Hospital, Rochester, NY.

Correspondence to: Ann R. Falsey, MD, Rochester General Hospital, 1425 Portland Ave, #246, Rochester, NY 14621-3001. E-mail: ann.falsey@rochestergeneral.org


Funding/Support: This study was funded by the National Institutes of Health-National Institute of Allergy and Infectious Disease [Grant 2UO1 AI045969-05A1].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1155-1161. doi:10.1378/chest.11-0047
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Rationale:  Systemic glucocorticosteroids (steroids) are commonly prescribed for patients with exacerbations of COPD during acute viral infections such as respiratory syncytial virus (RSV). The effects of short-term high-dose steroid treatment on viral load and adaptive immunity to RSV have not been examined in adults.

Objectives:  The objectives of this study were to measure peak viral load and duration of viral shedding, serum and nasal cytokines, RSV-specific antibody response, and lymphocyte subsets in patients admitted to the hospital with RSV infection and to compare patients treated with steroids to patients untreated with steroids.

Methods:  Hospitalized adults who tested positive for RSV by reverse transcription-polymerase chain reaction (RT-PCR) on admission had respiratory samples collected for quantitative RT-PCR and cytokine analysis. Serum and nasal secretions were tested for RSV antibody and lymphocyte subsets were analyzed by flow cytometry at 2 days, 2 weeks, and 1 month.

Main Results:  Thirty-three of 50 (66%) patients hospitalized with RSV received systemic steroids for a mean duration of 11 days. Those who received steroids more frequently wheezed and were less often febrile. There were no serious adverse events related to steroids and no significant differences in peak viral load, duration of RSV shedding, nasal cytokines, or lymphocyte subsets in patients treated with steroids and patients untreated with steroids. Antibody responses to RSV were slightly blunted in the steroid-treated group.

Conclusions:  Short courses of systemic steroids in patients hospitalized with RSV infection did not affect viral load or shedding. Humoral immunity may be mildly diminished, and thus potential benefits of systemic steroids must be balanced against potential risks.

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