What is the typical prednisone (corticosteroid) regimen for a patient with bronchitis?

Prednisone Regimen for Bronchitis

For severe paroxysms of postinfectious cough in bronchitis, a short course of prednisone at 30-40 mg per day for 5 days is recommended when other common causes of cough have been ruled out. 1

Understanding Bronchitis and the Role of Corticosteroids

Bronchitis can be classified as acute or chronic, with different treatment approaches for each:

Acute/Postinfectious Bronchitis

• Most cases are viral in origin and self-limited
• Antibiotics have no role in treatment unless bacterial infection is confirmed 1
• Initial management should focus on:
  • Inhaled ipratropium (may attenuate cough) 1
  • Inhaled corticosteroids if cough persists despite ipratropium 1

When to Consider Systemic Corticosteroids

Systemic corticosteroids (prednisone) should be considered in these specific situations:

1. Severe paroxysmal cough in postinfectious bronchitis:

   • Dosage: 30-40 mg prednisone daily
   • Duration: Short, finite period (5 days)
   • Prerequisites: Rule out other common causes of cough (upper airway cough syndrome, asthma, GERD) 1

2. COPD exacerbations:

   • Dosage: 40 mg prednisone daily
   • Duration: 5 days
   • Evidence shows this improves lung function, oxygenation, and shortens recovery time 1
   • Oral administration is equally effective as intravenous 1

Important Considerations and Caveats

• Do not use corticosteroids for bronchiolitis in children: Evidence shows no clinical benefit and potential for adverse effects 1

• Antibiotics should only be used when indicated by:

  • Increased sputum purulence
  • Increased dyspnea
  • Bacterial infection confirmed 1

• Central-acting antitussive agents (codeine, dextromethorphan) should be considered only when other measures fail 1, 2

Treatment Algorithm for Bronchitis

1. First-line treatment:

   • Inhaled ipratropium for cough 1
   • Short-acting bronchodilators for wheezing/airflow obstruction 2

2. If cough persists despite ipratropium:

   • Add inhaled corticosteroids 1

3. For severe paroxysmal cough:

   • Add prednisone 30-40 mg daily for 5 days 1
   • Monitor for improvement in symptoms

4. If purulent sputum present:

   • Consider appropriate antibiotics 1

5. For refractory symptoms:

   • Consider central-acting antitussives 1, 2

Special Considerations

• Patients with sputum eosinophilia may be more likely to respond to corticosteroid therapy 3
• Patients with underlying COPD or asthma may require different management approaches
• Longer courses of oral corticosteroids are not recommended due to side effect profiles 1

Remember that the primary goal of treatment is to improve morbidity, mortality, and quality of life by addressing the underlying cause of bronchitis and managing symptoms effectively.