Glucocorticosteroids (GCS), as the inhibitors of inflammatory reaction in the pleura, may exert a favourable influence on the course of tuberculous pleurisy (TP). GCS applied as an adjuvant therapy to antituberculosis treatment accelerate the regression of symptoms and signs and absorption of pleural fluid in a significant percent of patients. The controlled trials of treatment with GCS failed to show, however, any significant advantages in comparison to placebo with respect to prevention of pleural adhesions or restrictive disturbances of ventilation. Pleural thickening is observed in more than half of the patients, independently of antituberculosis treatment regimen and adjuvant therapy with GCS. A reduction of respiratory disability can be achieved as a result of early initiation of respiratory physiotherapy programme, even before completion of evacuation of pleural fluid. In the treatment of TP the same regimen is applied as in chemotherapy of pulmonary tuberculosis, although a tendency is observed for reduction of the number of antituberculosis drugs administered in combination. Nowadays, with increasing efficacy of antituberculosis chemotherapy, application of GCS is limited to selected cases of TP (mainly complicated by toxaemia and/or respiratory failure).
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