From the Guidelines
Prednisone should not be prescribed for mild lower respiratory tract infections unless there is a clear indication of significant inflammation or bronchospasm that is not responding to first-line treatments. For patients with postinfectious cough, the use of prednisone is considered only when the cough adversely affects the patient's quality of life and persists despite the use of inhaled ipratropium 1. In such cases, a short, finite period of prednisone (30 to 40 mg per day) may be considered when other common causes of cough have been ruled out 1. However, for most mild viral or bacterial bronchitis, common colds with chest symptoms, or mild coughs without significant airway obstruction, prednisone is not recommended as the risks often outweigh the benefits.
Key Considerations
- The use of prednisone in mild lower respiratory tract infections should be approached with caution due to the potential for adverse effects, including mood changes, increased blood sugar, fluid retention, and bone density loss with prolonged use.
- Supportive care with hydration, rest, and targeted symptom management should be the first approach for mild respiratory issues.
- Inhaled corticosteroids may be considered for patients with postinfectious cough that persists despite the use of inhaled ipratropium, but the evidence for this is based on expert opinion and has a grade of evidence of E/B 1.
- A more recent study on the use of corticosteroids in hospitalized patients with community-acquired pneumonia (CAP) suggests that corticosteroids may reduce mortality, shorten hospital stay, and reduce the need for mechanical ventilation, but this study is not directly applicable to mild lower respiratory tract infections 1.
Recommendations
- Prednisone should only be considered for mild lower respiratory tract infections when there is a clear indication of significant inflammation or bronchospasm that is not responding to first-line treatments.
- Patients with postinfectious cough that persists despite the use of inhaled ipratropium may be considered for a short course of prednisone (30 to 40 mg per day) when other common causes of cough have been ruled out.
- Supportive care with hydration, rest, and targeted symptom management should be the first approach for mild respiratory issues.
From the Research
Indications and Contraindications of Prednisone for Mild Lower Respiratory Tract Infections
- Prednisone, a corticosteroid, is not recommended for infants and children ages 1 to 23 months with bronchiolitis, a common lower respiratory tract infection 2.
- A study found that a 3-day course of oral corticosteroids is of no benefit to infants with mild to moderate bronchiolitis who are also treated with an inhaled beta2-agonist 3.
- For acute asthma, oral steroids are recommended, but the optimal dosing is unclear, and evidence is limited regarding the efficacy and safety of different oral steroid regimens 4.
- An exploratory analysis of the Oral Steroids for Acute Cough (OSAC) trial found no evidence to support the use of corticosteroids for acute lower respiratory tract infection in patients with clinically unrecognised asthma 5.
- Current evidence does not support the use of intranasal corticosteroids for symptomatic relief from the common cold, but further large, randomised, double-blind, placebo-controlled trials are required to answer this question 6.
Specific Considerations
- The use of bronchodilators and systemic corticosteroids is not recommended in infants and children ages 1 to 23 months with bronchiolitis 2.
- For school-aged children with mild to moderate pneumonia suspected to be of bacterial origin, amoxicillin is recommended, and a macrolide antibiotic should be prescribed if atypical pathogens are suspected 2.
- The diagnosis of lower respiratory tract infections, such as bronchiolitis and pneumonia, is clinical, based on the history and physical examination findings, and routine chest x-rays and blood tests are not recommended 2.