Abstract: Immune dysfunction plays a pivotal role in the pathogenesis and progression of severe viral pneumonia. Both hyperactivated immune responses and immunosuppressive states may adversely affect clinical outcomes. Glucocorticoids, widely utilized as immunomodulatory agents, hold significant therapeutic value in managing this condition. Elucidating the intricate mechanisms underlying immune dysregulation in these patients, accurately assessing individualized immune profiles, and optimizing glucocorticoid regimens alongside other immunomodulatory interventions are critical to improving clinical success rates. This review synthesized current progress in research on immune disorders and glucocorticoid therapy in severe viral pneumonia, providing theoretical foundations for clinical practice to enhance patient prognosis.