Corticosteroids, commonly referred to as steroids, are powerful medications used to treat illnesses affecting the nose, throat, or sinuses. Their use must be carefully considered against the nature of the illness being treated. Medical guidelines define specific, limited circumstances where these drugs are appropriate for respiratory issues, distinguishing them from routine use for everyday ailments. This information explores the science behind corticosteroids and the specific medical indications for their use during an upper respiratory infection.
Defining Upper Respiratory Infections
Upper respiratory infections (URIs) are acute illnesses that affect the structures of the upper respiratory tract, primarily the nose, sinuses, pharynx, and larynx. Most URIs, including the common cold, are caused by various types of viruses, such as rhinoviruses, coronaviruses, and adenoviruses. These infections are typically self-limiting, meaning the body’s own immune system successfully clears the virus without the need for specific medication.
Symptoms such as a runny nose, sore throat, congestion, and cough result from the body’s inflammatory response attempting to fight the viral invasion. Most viral URIs resolve within seven to ten days, with treatment focused on supportive care like rest and hydration. Understanding the viral nature of these infections is fundamental to determining why specific medical interventions are often unnecessary.
How Corticosteroids Affect the Body
Corticosteroids are a class of drugs chemically related to cortisol, a hormone naturally produced by the adrenal glands. These medications possess potent anti-inflammatory and immunosuppressive properties. They work by binding to the Glucocorticoid Receptor (GR) inside cells, which affects the transcription of numerous genes.
This process involves the repression of genes that produce pro-inflammatory substances, such as cytokines and chemokines, thereby reducing swelling and tissue damage. Corticosteroids also induce anti-inflammatory factors, helping to resolve the body’s immune reaction. Providers administer these drugs systemically (oral tablets or injections) or locally (nasal sprays or inhalers). Localized treatments concentrate the anti-inflammatory effect on the affected tissue while minimizing systemic absorption.
Specific Indications for Steroid Use
While corticosteroids do not treat the underlying viral cause of a URI, they are sometimes prescribed for severe complications arising from the resulting inflammatory response.
Pediatric Croup
One well-established indication is in pediatric patients with croup, a viral infection that causes swelling in the upper airway. In moderate to severe cases, a single dose of a systemic steroid, such as dexamethasone, is highly effective at reducing the airway swelling and alleviating the characteristic barking cough.
Chronic Condition Exacerbations
Corticosteroids may also be considered when a URI triggers an acute exacerbation of a pre-existing chronic condition, such as asthma or Chronic Obstructive Pulmonary Disease (COPD). The inflammation caused by the respiratory virus can severely narrow the lower airways, and a short course of systemic steroids rapidly reduces this swelling.
Other Inflammatory Conditions
In cases of acute rhinosinusitis, a post-viral complication involving significant sinus inflammation, systemic steroids combined with antibiotics may offer modest, short-term symptom improvement. Systemic steroids are sometimes used in limited adult cases of severe acute laryngitis where significant airway swelling is present. Evidence also supports their use for conditions like sinonasal polyposis, which can cause severe obstruction.
When Steroids Are Not the Appropriate Treatment
For the majority of uncomplicated viral URIs, such as the common cold, evidence does not support the use of systemic or intranasal corticosteroids for symptomatic relief. These drugs do not shorten the duration of the illness or target the virus itself, making them unnecessary for a condition that is self-limiting. Clinical guidelines generally advise against their routine prescription due to the potential for side effects.
Unnecessary use of systemic steroids carries several risks, even with short-term courses. Because of their immunosuppressive action, they can temporarily reduce the body’s ability to fight the infection, potentially delaying recovery or increasing the risk of secondary infections. Systemic side effects can include temporary mood changes, sleep disturbances, increased blood pressure, and elevated blood sugar levels.
Patients who have taken systemic steroids for longer periods may require a gradual tapering schedule, as abrupt cessation can lead to withdrawal symptoms. The standard treatment for most viral URIs remains supportive care, which includes over-the-counter pain relievers, nasal saline irrigation, and sufficient rest and fluids. Relying on symptom-masking drugs like steroids for mild viral infections can also potentially delay the diagnosis of a more serious underlying issue.