Dexamethasone has drawn renewed attention after evidence from ARDS research and the large RECOVERY trial suggested meaningful benefits in severe respiratory illness. Earlier ARDS studies showed steroids could ease inflammation and shorten time on ventilation, but effects on survival were unclear. The RECOVERY trial shifted that view by demonstrating lower mortality in hospitalized COVID-19 patients needing oxygen or mechanical ventilation when treated with low-dose dexamethasone. Benefits did not extend to patients without respiratory support, and important cautions remain. Past SARS experience linked high-dose or prolonged steroid use to complications such as avascular necrosis, underscoring the need for careful dosing, short treatment courses, and thoughtful follow-up when steroids are used in acute viral illness.