From the Guidelines
Steroids provide significant benefit in specific cases of bronchitis, particularly for patients with underlying asthma or COPD, or those with an acute exacerbation of chronic bronchitis. For typical viral bronchitis in otherwise healthy adults, corticosteroids like prednisone or dexamethasone are not recommended as they don't meaningfully improve outcomes and may expose patients to unnecessary side effects 1. However, for patients with an acute exacerbation of chronic bronchitis, a short course (10 to 15 days) of systemic corticosteroid therapy is recommended, with IV therapy in hospitalized patients and oral therapy for ambulatory patients having proven to be effective 1. Some key points to consider:
- In patients with chronic bronchitis, inhaled corticosteroid therapy should be offered to those with an FEV1 of < 50% predicted or for those patients with frequent exacerbations of chronic bronchitis 1.
- The use of oral corticosteroids in patients with chronic bronchitis has been discouraged due to the lack of evidence of benefit in stable patients and the potential for significant side effects 1.
- For patients with severe symptoms or significant wheezing, a healthcare provider might prescribe a brief steroid course, balancing the potential benefits against the risks of side effects including increased blood sugar, mood changes, and increased infection risk.
- Most cases of acute bronchitis resolve with supportive care including rest, hydration, and over-the-counter cough suppressants without requiring steroid treatment.
From the Research
Benefits of Steroids in Bronchitis
- Steroids, also known as corticosteroids, are anti-inflammatory drugs that have a proven beneficial role in various pulmonary conditions, including asthma and croup 2.
- However, the role of corticosteroids in bronchitis is controversial, and their use is often empirical due to a lack of clear evidence in favor 2.
- Some studies suggest that corticosteroids may be beneficial in certain cases of bronchitis, such as in patients with chronic bronchitis and acute respiratory insufficiency 3.
- A study found that methylprednisolone improved airflow more than placebo when added to standard therapy in patients with chronic bronchitis and acute respiratory insufficiency 3.
- Another study found that prednisone produced a striking decrease in lower respiratory tract neutrophils in patients with bronchiolitis, suggesting a central role for neutrophils in the condition 4.
Predictors of Response to Steroids
- Sputum cell examination revealing a preponderance of eosinophils or occasional clumps of eosinophils may be a good predictor of a favorable response to steroid therapy in patients with chronic bronchitis 5.
- Blood eosinophil count was not found to be a reliable predictor of response to steroids in patients with chronic bronchitis 5.
Safety and Efficacy of Inhaled Corticosteroids
- Inhaled corticosteroids (ICS) have been developed to maximize effective treatment of lung diseases characterized by inflammation and reduce the frequency of harmful effects 2.
- However, the use of ICS in adults with stable state bronchiectasis is not supported by sufficient evidence, and their routine use is not recommended 6.
- The safety and efficacy of ICS in children with bronchiectasis or in adults during an acute exacerbation are unknown due to a lack of studies 6.