From the Guidelines
For post-viral bronchitis, a short course of 30 to 40 mg of prednisone per day is recommended for a finite period of time, as stated in the 2006 Chest guidelines 1. This approach is suggested when other common causes of cough have been ruled out and the cough persists despite other treatments, such as inhaled ipratropium. The use of prednisone in this context is based on a low level of evidence but is considered to have an intermediate net benefit, with a grade of evidence of C 1. Key considerations for the use of prednisone in post-viral bronchitis include:
- Ruling out other causes of cough, such as bacterial sinusitis or gastroesophageal reflux disease
- Using prednisone for a short, finite period to minimize side effects
- Monitoring for common side effects, including increased appetite, mood changes, insomnia, and elevated blood glucose
- Continuing any prescribed inhalers during the prednisone course
- Seeking medical attention if symptoms worsen despite treatment It's also important to note that antibiotics have no role in the treatment of post-viral bronchitis, as the cause is not bacterial infection, and central acting antitussive agents such as codeine and dextromethorphan may be considered when other measures fail 1.
From the FDA Drug Label
The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT
The recommended course of Prednisone for post-viral bronchitis is not explicitly stated in the drug label.
- Dosage requirements are variable and must be individualized based on the disease under treatment and the response of the patient.
- The drug label does not provide a specific dosage recommendation for post-viral bronchitis 2.
From the Research
Recommended Course of Prednisone for Post-Viral Bronchitis
There is limited evidence to support the use of prednisone for post-viral bronchitis. However, some studies provide insight into the use of corticosteroids in similar conditions:
- A study on chronic bronchitis found that 7 out of 24 patients responded favorably to prednisone 30 mg daily for one week, with an increase in FEV1 greater than 30% of the control value 3.
- Another study on infants with mild to moderate bronchiolitis found that a 3-day course of oral prednisone (2 mg/kg/day) was of no benefit when added to beta2-agonists 4.
- There is no direct evidence on the recommended course of prednisone for post-viral bronchitis, but these studies suggest that corticosteroids may be beneficial in certain cases of chronic bronchitis, but not in mild to moderate bronchiolitis.
Treatment Options for Acute Bronchitis
The treatment options for acute bronchitis are primarily focused on symptomatic relief, as the condition is often self-limiting:
- Nonpharmacological and pharmacological options are available, including antitussive agents, protussive agents, and beta-2-agonists 5.
- Antibiotics are generally not indicated for bronchitis, unless pertussis is suspected or the patient is at increased risk of developing pneumonia 6.
- The use of cough and cold preparations is not recommended in children younger than six years, and effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction 6.
Management of Post-Viral Cough
Post-viral cough can be managed with a combination of a β-agonist and an anticholinergic agent:
- A randomized, double-blind, placebo-controlled trial found that a combination of salbutamol and ipratropium bromide significantly reduced daytime and nighttime cough severity in patients with post-viral cough 7.
- The frequency of adverse events was not significantly different between the treatment and placebo groups, and small but significant increases in spirometric parameters were observed in the treatment group 7.