Immune response can damage lungs

Dear Dr. Roach: Why would a chest disease specialist prescribe steroids for chest infection from COVID if it suppresses the body’s immune system?

A.K.

Answer: Damage to lung tissue can come directly from an infection with a bacteria, virus or other pathogen.

However, additional damage may occur as a result of the body’s overvigorous response to some specific infections. By using steroids to slightly reduce the body’s inflammatory response, lung damage can be lessened. This is particularly important when oxygen levels are very low, as might be the case during severe infection.

I understand why you are concerned about potential suppression of the immune system, but there is a proven benefit in severe infections with some specific organisms. COVID-19 is one example, but there are others.

In the case of COVID-19, steroids are beneficial when the infection is quite severe, as evidenced by the need for supplemental oxygen. COVID patients who need oxygen and would benefit from steroids should be in the hospital, if the community has hospital beds available.

I want to mention that for people with COVID-19 who are at risk for severe disease, but who do not meet criteria for hospital admission (say, those with low oxygen), there are treatments that reduce risk of hospitalization.

Monoclonal antibody treatments have increasingly been shown to be effective and are much more available than they used to be. They should ideally be used within three days of symptoms, but no more than 10.

Risk factors that warrant consideration of monoclonal antibody treatment are severe overweight or obesity; chronic kidney disease; diabetes; immunosuppression by disease or treatment; being over 65; or being over 55 with heart disease, high blood pressure or chronic obstructive pulmonary disease (or other chronic respiratory disease). Early studies show that these treatments can dramatically reduce the risk of developing severe disease.