Impact of inhaled corticosteroid use on elderly chronic pulmonary disease patients with community acquired pneumonia

To the Editor:With an aging global population,the incidences of community-acquired pneumonia(CAP)and chronic obstructive pulmonary disease(COPD)have signicantly increased.[1]Previous studies have conrmed that COPD and asthma are independently associated with the prevalence of CAP.The use of inhaled corticosteroid(ICS),the cornerstone of treatment for asthma,COPD with frequent acute exacerbations,and asthma-COPD overlap(ACO)may induce changes in the local lung microbiome and abnormal lung immunity,ultimately,causing a signicantly increased risk of pneumonia.However,in cases of pneumonia,the effect of the use of ICS on CAP mortality remains controversial.While data from one study favored the prior use of ICS,which was associated with a signicantly lower short-term mortality rate,[2]other studies have identied no impact on mortality.To date,data on the impact of the use of ICS on mortality,prehospitalization or during hospitalization,are scarce,particularly in the older population.Therefore,this multicenter,retrospective study explored the association between the use of ICS during hospitalization and short-term mortality in older patients with CAP and those with chronic pulmonary disease(CPD).

Sirolimus combined with oseltamivir and corticosteroid treatment for a puerpera with severe pneumonia caused by 2009 pandemic H1N1:A case report

Severe pneumonia in patients infected with the 2009 pandemic H1N1(pH1N1)virus was partially attributed to excessive immune response.Anti-virus treatment for these patients was insufficient.Here we reported the therapy effect of sirolimus,an immunosuppressor,combined with oseltamivir and corticosteroid for a puerpera with severe pneumonia caused by pH1N1 virus.This patient has infected with the pH1N1 virus in late pregnancy,and antiviral therapy was not implemented timely.She developed severe pneumonia and ARDS rapidly and need receive a cesarean section on the 39th week after pregnancy.After giving birth to a healthy baby,she received a combination of oseltamivir,sirolimus and corticosteroid,and improved in the following days.Moreover,the cytokines in serum and viral loads in BALF decreased significantly.She recovered without infectious symptoms and was discharged.Sirolimus combined with oseltamivir and corticosteroid is likely responsible for lowering the viral loads,reducing the patient's cytokine level,and further improving her clinical outcomes.It provides evidence that adjuvant treatment was beneficial to patients with severe pneumonia induced by the pH1N1 virus.