Common sense made me think of the need for inflammation reduction in case of pneumonia and the anti-inflammatory characteristics of inhaled corticosteroids. I Googled and found a study1 from 2017 that suggests that corticosteroids might indeed reduce inflammation in severe pneumonia. But it seems that as far as I could find and also from what I understand from a befriended general practitioner the use of inhaled corticosteroids for pneumonia isn't common practice, if ever used at all. Why is this?

Specifically in the case of pneumonia I would think that inhaling any medicine with anti-inflammatory properties such as corticosteroids is potentially the best possible way to get the medicine where you want it to be, in the lungs. Is there a reason why inhaled corticosteroids aren't used (in addition) for treatment of pneumonia?

1 Corticosteroids might reduce pulmonary inflammation in severe pneumonia, preventing respiratory failure (Mandell 2015). - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486210/

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    Common sense is not very sensible when it comes to physiology. Common sense doesn't inform you of particle size of a nebulized or aerosolized medication or where the damage is being done in pneumonia. If common sense informed medical decisions, why not administer antibiotics through nebulization? (It's been tried.) Aug 26, 2021 at 15:27
  • @anongoodnurse "antibiotics through nebulization" is an interesting thought, what were the results of that? I merely said common sense was the inspiration for this question also it means just "the basic level of practical knowledge and judgment". I'd be terrifying not to use the basic level of practical knowledge and judgement (common sense). The question should be whether the basic level of knowledge is sufficient.
    – Bob Ortiz
    Aug 27, 2021 at 7:10
  • Neither work. Aerosolization/nebulization only works for relaxation of bronchial smooth muscle in upper airway disease (asthma, COPD, etc.), and antibiotics are not given that way. Common sense isn't very common or sensible. Two semesters of Physics will absolve almost anyone of that illusion. Aug 27, 2021 at 11:31

1 Answer 1


It would seem that the evidence is that (injected) corticosteroids don't help much unless the disease is severe (septic shock) and/or has a high inflammatory response, in which case there is some evidence to suggest that they do help, but otherwise no benefit.

As to why they don't use inhaled - I don't know. Perhaps because we already have very effective drugs (e.g. salbutamol) for this, which don't have the longer term dependence/weaning problems that corticosteroids do.


Ceccato, A., Russo, A., Barbeta, E. et al. Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study. Crit Care 25, 432 (2021). https://doi.org/10.1186/s13054-021-03840-x

Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2017 Dec 13;12(12):CD007720. doi: 10.1002/14651858.CD007720.pub3. PMID: 29236286; PMCID: PMC6486210.

  • Isn't salbutamol a corticosteroid? Because that's exactly what I had in mind with "inhaled corticosteroids".
    – Bob Ortiz
    Jan 31, 2023 at 22:23
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    @BobOrtiz, no it isn't - I thought it was too, but checked and it turns out it is a B-adrenergic agonist. Technically a stereo-isomeric mix though. There are corticosteroid inhalers - if you have asthma you might have a "preventative" one which is corticosteroid (mometasone, fluticasone budesonide, etc.)
    – bob1
    Jan 31, 2023 at 22:27

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