can we use steroids in cases of bronchiectasis with tuberculosis or that may cause bad prognosis ?
Steroids are not commonly used in bronchiectasis due to tuberculosis - either systemic or inhaled. In fact the use of systemic steroids in the background of TB is limited as in - TB meningitis, TB pericarditis, Adrenal dysfunction.
Besides chance of increased chance of bacterial infection there is also the possibility of increased recurrence of TB with use of steroids.
The short response is: NOT indicated
The long response is: It can be an alternative to other anti-inflammatory treatments in exacerbator patients in the case of non-response to this treatment (for example: macrolides), always at the lowest dose possible.
The exceptions: 1. The presence of concomitant asthma. In this case inhaled steroids are needed. 2. Use of systemic steroids (like COPD) in severe exacerbations (usually required hospitalization).
Animesh Ray I understand the risk of steroids on tuberculosis but in some critical cases , we need to use steroids by caution
In cases that Prof MA Martinez-Garcia mentions
MA Martinez-Garcia Surely macrolides in less dose as possible because of the cardiac risk /
Regarding systemic steroids , from an experience, it may help in the cases on mechanical ventilation only
@MA Martinez -Garcia
Oral glucocorticoids –systemic glucocorticoids are reserved for acute exacerbations of bronchiectasis that are accompanied by wheezing suggestive of concomitant asthma or allergic bronchopulmonary aspergillosis....in either case it is not the bronchiectasis that is being treated rather the concomitant condition.
Inhaled steroids - insufficient evidence in the absence of copd or asthma.
I agree with Animesh sir. BTS (2019) and even older ERS (2018) guidelines mention the same.
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