Of course your asthma patients with acute bronchitis will get some steroids….but what about your non-asthmatic patients?  Evidence shows that most patients with acute bronchitis do not need steroids.

What’s the evidence?

Study: double-blinded RCT of 401 patients with lower respiratory tract infection symptoms (wheezing) without history of asthma or COPD treated at different family practice clinics in Britain

Comparison: 40mg Prednisolone or placebo daily for 5 days

Outcome: no difference in primary or secondary outcomes

  • Primary outcomes: duration of moderately bad or worse cough, mean severity of symptoms on days 2-4
  • Secondary outcomes: duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, adverse events

 

Take home point: bronchitis without underlying lung pathology does not need steroids

Hay AD, 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 Aug 22;318(8):721-730.

Thanks to Dr. Trevor Pour for the pearl inspiration!