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ARTICLE

Oral Prednisone Found to be Ineffective Against Bronchitis Symptoms

AUG 30, 2017 | CONTAGION® EDITORIAL STAFF
Bronchitis is a respiratory infection caused by inflammation of the pathways that carry air to an individual’s lungs, the bronchial tubes. Because the infection is usually caused by a virus, antibiotics should not be prescribed as treatment and instead, medications to help deal with the symptoms, such as Tylenol for pain or fever, are prescribed. Sometimes, doctors will also prescribe a steroid to help decrease the inflammation; however, the results of a new study have found that this may be both unnecessary and ineffective.

For the multicenter, placebo-controlled, randomized trial, published in the Journal of the American Medical Association, researchers from the University of Bristol in England, “tracked outcomes for nearly 400 adults with acute (short-term) lower respiratory tract infections,” according to a press release on the study. The trial was conducted in 54 family practices in England from July 2013 to October 2014 (month of final follow-up).

Half of the patients received 40 mg/d of oral prednisolone for 5 days, while the other half received a placebo, also for 5 days. None of patients suffered from asthma, or had a history of “chronic pulmonary disease or use of asthma medication in the past 5 years,” according to the study. In addition, none of the patients had a bacterial infection that would require antibiotics.

The results showed that, “Among the 398 patients with baseline data (mean age, 47 [SD, 16.0] years; 63% women; 17% smokers; 77% phlegm; 70% shortness of breath; 47% wheezing; 46% chest pain; 42% abnormal peak flow), 334 (84%) provided cough duration and 369 (93%) symptom severity data. Median cough duration was 5 days (interquartile range [IQR], 3-8 days) in the prednisolone group and 5 days (IQR, 3-10 days) in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89-1.39; P = .36 at an α = .05). Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, −0.20; 95% CI, −0.40 to 0.00; P = .05 at an α = .001). No significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, or nonserious adverse events. There were no serious adverse events.”

Because there were no reductions in the severity or duration of cough or other symptoms as a result of the steroid (when compared with the placebo group), the authors do not recommend the use of steroids for treating the symptoms of bronchitis in patients without asthma. To this end, lead study researcher, Alastair Hay, MD, primary care professor at the University of Bristol, stated in the press release, “Our study does not support the continued use of steroids as they do not have a clinically useful effect on symptom duration or severity. We would not recommend their use for this group of patients.”

Steroid medications can be used to successfully relieve asthma symptoms; and so, although he is heartened to hear that doctors have more evidence to support not prescribing steroids for these infections, Len Horovitz, MD, a pulmonary specialist at Lenox Hill Hospital in New York City, New York, stated in the press release, “In adults with asthma, any infection may cause a flare of asthma, and steroids might be indicated in this population of patients, depending on the severity of the asthma symptoms.”
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