Corticosteroid Use in Pulmonary Fibrosis

Introduction to Corticosteroid Therapy

The European Respiratory Society recommends that corticosteroids are not used for routine treatment of idiopathic pulmonary fibrosis (IPF) except during acute exacerbations, where high-dose therapy is used 1, 2, 3
The American Thoracic Society suggests that long-term corticosteroid monotherapy is associated with substantial morbidity without proven benefit in IPF patients 1
Low-dose oral prednisone (up to 10 mg daily) may sometimes be used to alleviate incapacitating cough in IPF patients, as recommended by the European Respiratory Society 1
For acute exacerbations of IPF, high-dose corticosteroid therapy is recommended by the European Respiratory Society 1, 2

After initial high-dose therapy for acute exacerbations of IPF, a gradual taper is typically implemented, as suggested by the American Journal of Respiratory and Critical Care Medicine 4, 5
The American Journal of Respiratory and Critical Care Medicine recommends that prednisone be started at 0.5 mg/kg lean body weight daily for 4 weeks, then reduced to 0.25 mg/kg lean body weight daily for 8 weeks, and finally tapered to 0.125 mg/kg daily or 0.25 mg/kg every other day in combination therapy for IPF 5

The European Respiratory Society and the American Journal of Respiratory and Critical Care Medicine state that corticosteroid monotherapy is associated with substantial long-term morbidity, including glucose metabolism abnormalities, cataracts, growth retardation in children, and increased susceptibility to infections 1, 4, 6, 7
The American Journal of Respiratory and Critical Care Medicine notes that in adults with pulmonary fibrosis, there is particular concern for development of osteoporosis and diabetes 7

The European Respiratory Society suggests that for symptom management only, low-dose prednisone (up to 10 mg daily) may help alleviate severe cough in IPF 1
The European Respiratory Society recommends that newer antifibrotic medications are now preferred over corticosteroids for IPF management 8
The American Journal of Respiratory and Critical Care Medicine and the European Respiratory Society note that for non-IPF pulmonary fibrosis, corticosteroids may still play a role in management 4, 8

The European Respiratory Society and the American Journal of Respiratory and Critical Care Medicine advise against using corticosteroids as monotherapy for IPF as they provide no survival benefit and cause significant side effects 1, 2, 8
The American Journal of Respiratory and Critical Care Medicine recommends that corticosteroid therapy should not be continued indefinitely without objective evidence of continued improvement or stabilization 5
The American Journal of Respiratory and Critical Care Medicine suggests that the risk-benefit ratio should always be considered, especially in older patients (>70 years) or those with comorbidities such as diabetes, obesity, or osteoporosis 5