Corticosteroid Responsiveness in Post-COVID-19 Interstitial Lung Disease: A Systematic Review of Clinical Outcomes and Pulmonary Function Recovery

Elaf Almdabgy, Jameelah Allihaibi

Abstract: Background: Post-COVID-19 interstitial lung disease (ILD) has emerged as a significant long-term complication of SARS-CoV-2 infection, characterized by persistent inflammation, impaired gas exchange, and varying degrees of fibrosis. Corticosteroids are widely used based on their anti-inflammatory effects, yet the magnitude of benefit, ideal patient selection, and long-term safety remain uncertain due to heterogeneous evidence. Objective: To systematically evaluate the clinical effectiveness and safety of corticosteroid therapy in adults with post-COVID-19 ILD, with a focus on pulmonary function recovery, radiologic patterns, functional capacity, symptoms, and adverse events. Methods: A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from January 2020 onward. Eligible studies included adult cohorts receiving systemic corticosteroids for post-COVID-19 ILD and reporting respiratory or radiologic outcomes. Two reviewers independently screened studies, extracted relevant data, and assessed methodological rigor using the Newcastle-Ottawa Scale. Due to substantial heterogeneity in disease characteristics, treatment regimens, and outcome reporting, data were synthesized narratively. Certainty of evidence was assessed using GRADE. Results: Twelve observational studies involving 18-2,026 participants with 3-12 months of follow-up met inclusion criteria. Prednisolone or methylprednisolone tapers were the primary interventions, sometimes combined with mycophenolate or other agents in progressive disease. Across studies with organizing pneumonia-like or predominantly inflammatory ILD, corticosteroid therapy was consistently associated with improved diffusion capacity (DLCO), forced vital capacity (FVC), oxygen discontinuation, dyspnea reduction, and enhanced exercise tolerance. Radiologically, resolution of ground-glass opacities and consolidations was frequently observed. In contrast, patients with established fibrosis, traction bronchiectasis, or honeycombing demonstrated limited improvement. Reported adverse effects were mostly mild and reversible, including hyperglycemia, weight gain, and steroid-related myopathy; however, long-term safety data were limited. The certainty of evidence was rated low for symptomatic and functional improvement and very low for long-term outcomes. Conclusions: Corticosteroids appear to confer short-term functional and clinical benefits in selected patients with post-COVID-19 ILD, particularly those with persistent inflammatory disease. Their role in modifying fibrotic progression or improving long-term outcomes remains uncertain. High-quality controlled studies are needed to optimize therapeutic strategies and define risk-benefit profiles.

Keywords: Post-COVID-19 interstitial lung disease, Long COVID, Corticosteroids, Organizing pneumonia, Pulmonary fibrosis, Diffusion capacity, Pulmonary function tests

How to Cite?: Elaf Almdabgy, Jameelah Allihaibi, "Corticosteroid Responsiveness in Post-COVID-19 Interstitial Lung Disease: A Systematic Review of Clinical Outcomes and Pulmonary Function Recovery", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 316-325, https://www.ijsr.net/getabstract.php?paperid=SR26630190136, DOI: https://dx.doi.org/10.21275/SR26630190136

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