From the Guidelines
For patients with acute bronchitis, a short course of systemic corticosteroid therapy, such as 10 to 15 days of oral or IV steroids, is recommended to reduce inflammation and improve symptoms. This recommendation is based on the highest quality evidence available, which suggests that systemic corticosteroids can provide substantial benefits for patients with acute exacerbations of chronic bronchitis 1.
Key Considerations
- The use of systemic corticosteroids, such as oral prednisone, can help reduce inflammation and relieve symptoms like cough and wheezing.
- Inhaled corticosteroids, like fluticasone or budesonide, may be used for less severe cases or for patients with underlying asthma or COPD.
- Short-term steroid use generally has minimal side effects, but patients should be aware of potential risks like temporary insomnia, increased appetite, or mood changes.
- Steroids should be used alongside other treatments, such as staying hydrated, using humidifiers, and taking over-the-counter cough suppressants if needed.
Treatment Duration and Monitoring
- Patients should complete the full prescribed course of steroids, even if symptoms improve quickly.
- If symptoms worsen or don't improve after a few days of treatment, medical reassessment is recommended to adjust the treatment plan as needed.
- The benefits of systemic corticosteroids for acute bronchitis are believed to outweigh the risks, particularly when used for short-term treatment 1.
From the Research
Steroid Use in Bronchitis
- The use of steroids in bronchitis is not universally recommended, as the effectiveness and appropriateness of steroid treatment vary depending on the specific condition and patient population 2, 3, 4.
- For acute bronchitis, evidence does not support the use of inhaled or oral corticosteroids, as the condition is self-limiting and symptom relief is the primary management strategy 2, 5.
- In contrast, systemic corticosteroids are standard care for managing acute exacerbations of chronic obstructive pulmonary disease (COPD), with low-dose regimens such as prednisone 40 mg orally once/day for 10-14 days being recommended 3.
- For chronic bronchitis, corticosteroid response is more favorable in patients with sputum eosinophilia, suggesting that steroid therapy may be beneficial in specific cases 4.
- Overall, the decision to use steroids in bronchitis should be based on individual patient characteristics, disease severity, and the presence of specific indicators such as eosinophilia or COPD exacerbation 3, 4, 6.