Oral corticosteroids, such as prednisolone, do not reduce symptom duration or severity for acute lower respiratory tract infection in adults without asthma and therefore should not be used, according to a study published in JAMA.
Alastair D Hay, FRCGP, from the Centre for Academic Primary Care at the University of Bristol in the UK, and colleagues conducted a multicenter, placebo-controlled, randomized trial of 401 adults with acute cough and at least 1 lower respiratory tract symptom not requiring immediate antibiotic treatment. Participants had no history of chronic pulmonary disease or use of asthma medication within the past 5 years.
Patients were either prescribed two 20-mg prednisolone tablets (n = 199) or matched placebo (n = 202) once daily for 5 days. The dose and duration of prednisolone were selected to reflect the dose and duration known to be effective for acute asthma.
The primary outcomes were duration of moderately bad or worse cough (0 to 28 days) and mean severity of symptoms on days 2 to 4 (scored from 0 [not affected] to 6 [as bad as it could be]). Secondary outcomes were duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, and adverse events.
Among 401 randomized patients, 2 withdrew after randomization, and 1 duplicate patient was identified. Among the 398 patients with baseline data (mean age, 47 years; 63% women; 17% smokers; 77% had phlegm; 70% had shortness of breath; 47% had wheezing; 46% had chest pain; 42% had abnormal peak flow), 334 (84%) provided cough duration, and 369 (93%) had symptom severity data.
Median cough duration was 5 days in the prednisolone group and 5 days in the placebo group (adjusted hazard ratio, 1.11). Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, -0.20). 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.
“This trial suggests that oral corticosteroids should not be used in adult primary care patients without asthma or chronic obstructive pulmonary disease who do not require treatment with an immediate antibiotic,” concluded the authors.
- Hay AD, Little P, Harnden A, et al. Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: A randomized clinical trial. JAMA. 2017;318:721-730. doi: 10.1001/jama.2017.10572