Early corticosteroid treatment for severe pneumonia caused by 2009 H1N1 influenza virus

A virus infection occurred worldwide in 2009. Some previously healthy patients experienced rapidly progressive pneumonia leading to acute respiratory distress syndrome (ARDS) and even death. Th e eff ect of corticosteroids on these severely aff ected patients is controversial because of a lack of controlled clinical trials [1]. During the pandemic in South Korea, we observed that early, short-term cortico steroid treatment along with oseltamivir seemed to have a dramatic eff ect on patients with severe pneumonia, and we proposed a new theory for the pathogenesis of acute lung injury in infl uenza virus infections [2]. In that study, we wanted to evaluate this benefi cial eff ect of cortico steroid treatment through comparative data based on the use or non-use of corticosteroids at two separate hospitals. Th e subjects of the study were the pneumonia patients who had severe respiratory distress with hypoxe mia at presentation or during admission and who thus required oxygen therapy. Th e conditions of 17 patients (median of 6 years of age, range of 4 to 9) in our hospital (use of corticosteroids) and 15 patients (median of 6 years of age, range of 5 to 18) in a neighboring hospital South Korea) (non-use of corticosteroids) were diag nosed by reverse transcriptase-polymerase chain reac tion. Th e clinical and laboratory characteristics of patients in the two hospitals are shown in Table 1. Our results suggested that the severe pneumonia patients who were treated with cortico steroids showed shortened durations of fever and oxygen therapy, rapid resolution of pneumonic infi ltrations, and possibly no progression to ARDS. It is reported that corticosteroid treatment for adult ARDS patients with 2009 H1N1 virus infection was eff ective in the improvement of lung injury score [3]. Two recent case series suggest a possible life-saving role of corticosteroids in severely ill adult patients with 2009 H1N1 virus infection unresponsive to other treatments [4,5]. Corticosteroids may not increase the viral load of the patients [4]. To the best of our knowledge, our study may be the fi rst trial addressing an early and preemptive modality before ARDS development in infl uenza virus infections. Our policy of corticosteroid treatment with a rapid, high-dose (methylprednisolone, 10 mg/kg per day), and short-term (tapered off within a week) schedule did not show any complications in our patients and may avoid the complications that arise from long-term corticosteroid use. Although rapid corticosteroid treatment for patients …