Systemic corticosteroids decrease the effectiveness of talc pleurodesis.

Corticosteroids can inhibit the inflammatory process and the formation of fibrosis. The purpose of this study was to determine whether the concurrent use of steroids at the time of talc-slurry pleurodesis would influence the development of the pleurodesis. One group of rabbits received an intrapleural injection of talc (400 mg/kg) and an intramuscular injection of triamcinolone (0.8 mg/kg) 1 d before talc instillation and weekly thereafter, whereas a control group received only talc. Ten rabbits in each group were killed at 6 h and at 1, 2, 4, 7, 14, and 28 d after instillation. The mean volume of pleural fluid was significantly lower in the group receiving corticosteroids at 6 h through 4 d after talc slurry than in the other groups. The degree of pleural adhesion was significantly smaller in the group receiving corticosteroids from Day 2 through Day 28. At Day 28, all 10 rabbits that received talc only had a pleurodesis score of 3 or 4, whereas only four of the 10 rabbits that also received steroids had a pleurodesis score of 3 or 4. This study shows that the use of corticosteroids at the time of talc-slurry pleurodesis markedly decreases the inflammatory reaction to the talc, and essentially prevents a pleurodesis from developing.