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• W1974274457 abstract "Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. We read with interest the recent editorial (CHEST 1995; 107:1486-87) accompanying the article (CHEST 1995; 107:1621-30) on corticosteroids in pulmonary tuberculosis (TB), and we wish to highlight a few additional points on the use of corticosteroids in the management of TB.1Allen MB Cooke NJ Corticosteroids and tuberculosis.BMJ. 1991; 303: 871-872Crossref PubMed Scopus (25) Google Scholar A small number of patients with post primary TB may also have true Addison's disease due to tuberculous destruction of the adrenal gland.2Ellis ME Tayoub F Adrenal function in tuberculosis.Br J Dis Chest. 1986; 80: 7-12Abstract Full Text PDF PubMed Scopus (41) Google Scholar With the “stress” of the infection and the use of rifampicin, which increases steroid metabolism some two to three fold,3McAllister WA Thompson PJ Al -Habet SM et al.Rifampicin reduces effectiveness and bioavailability of prednisolone.BMJ. 1983; 286: 923-925Crossref PubMed Scopus (168) Google Scholar patients can develop adrenal failure.4Wilkins EGL Hnizdo E Cope A Addisonian crisis induced by treatment with rifampicin.Tubercle. 1989; 70: 69-73Abstract Full Text PDF PubMed Scopus (23) Google Scholar This may be one explanation for the early mortality that occurs with TB, in spite of patients receiving appropriate therapy.5Ellis ME Webb AK Cause of death in patients admitted to hospital for pulmonary tuberculosis.Lancet. 1983; 1: 665-667Abstract PubMed Scopus (39) Google Scholar Identification of such patients and use of steroids as replacement therapy is one area that should always be considered and was not discussed in the editorial. Additionally, steroids have a major use in the management of pleural disease beyond “patients with extensive primary tuberculosis with a large pleural effusion” (CHEST 1995; 107:1486-87). Several studies have confirmed the advantage of systemic steroids in limiting the pleural fibrosis that may occur;6Fleishman SJ Coetzee AM Mindel S et al.Antituberculosis therapy combined with adrenal steroids in the treatment of pleural effusions a theraputic trial.Lancet. 1960; 1: 199-201Abstract PubMed Scopus (7) Google Scholar, 7Lee CH Wang WJ Lan RS et al.Corticosteroids in the treatment of tuberculous pleurisy: a double-blind, placebo controlled, randomized study.Chest. 1988; 94: 1256-1259Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar, 8Paley SS Mihaly JP Mais EL et al.Prednisolone in the treatment of tuberculous pleural effusions.Am Rev Tuberc. 1959; 79: 307-314PubMed Google Scholar intrapleural steroids confer no advantage.9Menon NK Steroid therapy in tuberculous effusion.Tubercle. 1964; 45: 17-20Abstract Full Text PDF PubMed Scopus (12) Google Scholar In one study10Barbas CSV Cukier A De Varvalho CRR et al.The relationship between pleural fluid findings and the development of pleural thickening in patients with pleural tuberculosis.Chest. 1991; 100: 1264-1267Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar where steroids were not used in the management of pleural disease, an unacceptable 23 of 44 patients developed this complication despite effective chemotherapy. Furthermore, tuberculous pleural effusions may be a greater problem in older patients with reactivation of previous disease.11Epstein DM Kline LR Albelda SM et al.Tuberculous pleural effusions.Chest. 1987; 91: 106-109Crossref PubMed Scopus (161) Google Scholar, 12Moudgil H Sridhar G Leitch AG Reactivation disease: the commonest form of tuberculous pleural effusion in Edinburgh, 1980-1991.Respir Med. 1994; 88: 301-304Abstract Full Text PDF PubMed Scopus (56) Google Scholar These patients, like those with a primary disease producing pleural effusions, should not be denied the benefit of steroids, which not only improve their constitutional symptoms but also limit the development of pleural fibrosis." @default.
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• W1974274457 title "Pulmonary Tuberculosis and Steroids" @default.
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• W1974274457 doi "https://doi.org/10.1378/chest.109.2.582" @default.
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