Study: Steroids don't aid survival from lung illness

The steroids often used to treat advanced respiratory distress syndrome, a lung condition, don't improve survival and may increase death rates, a study found.

About 150,000 Americans develop respiratory distress each year, typically patients with another illness like pneumonia or recovering from traumatic accidents such as car wrecks. No drugs are approved to treat the life-threatening condition, caused by inflammation in the lungs and marked by breathing failure.

Previous research found steroids failed to improve survival in newly diagnosed patients. Still, researchers hoped the ability of steroids to counteract inflammation would benefit those struggling with the condition for more than a week. The largest rigorous study done to date put an end to those hopes.

''The important message here is that mortality was not decreased," said Andrea Harabin of the National Heart, Lung, and Blood Institute, a US agency that funded and helped conduct the research, in an April 18 phone interview. Many doctors ''will not be tempted to use" steroids on patients.

The seven-year study involved 180 patients breathing with the help of a ventilator and diagnosed with acute respiratory distress syndrome one week to 28 days earlier. After two months, 29.2 percent of those on steroids and 28.6 percent getting a placebo had died. One-third of both groups died after six months, the study in today's issue of the New England Journal of Medicine found.

Death rates were significantly higher among those getting steroids when the treatment began more than two weeks after the onset of the condition. After 60 days, 8 percent of those patients receiving a placebo and 35 percent of those on steroids died, the study found. The gap remained up to six months later.

There were ''tantalizing" signs that steroids might help some patients, said Harabin, a lead investigator and project officer at the US government research network established to study respiratory distress.

Days spent on a ventilator and in shock were lower after 28 days among those taking steroids, which also seemed to improve oxygen levels in the blood, the study found. At the same time, patients getting steroids also were more likely to go back onto a ventilator and were more likely to suffer severe muscle weakness.

''The current study suggests that there is a narrow window of opportunity, between seven and 14 days after the onset of disease," in which heart and lung function and survival may be improved, said Peter M. Suter, vice rector at the University of Geneva, in an accompanying editorial. Additional research is needed to identify the optimal timing and dose, he said.