Can oral steroids (corticosteroids) inhibit a dry cough?

Oral Steroids for Dry Cough: Efficacy and Recommendations

Oral corticosteroids can effectively inhibit dry cough, particularly in conditions like asthma, eosinophilic bronchitis, and sarcoidosis, but should be used for short courses (1-2 weeks) due to potential side effects. 1

Mechanism and Efficacy

Oral corticosteroids work by reducing airway inflammation, which is often the underlying cause of persistent dry cough. Their effectiveness varies depending on the underlying condition:

• Asthma-related cough: Oral corticosteroids are highly effective for cough variant asthma, with studies showing complete resolution of cough within 1-2 weeks of treatment with prednisone 30-40mg daily 2, 3

• Non-asthmatic eosinophilic bronchitis: Oral steroids are effective when inhaled corticosteroids fail to control symptoms 1

• Sarcoidosis-related cough: Oral corticosteroids improve cough symptoms, spirometry findings, and chest radiographic abnormalities over 6-24 months 2

• Inflammatory bowel disease-related bronchiolitis: Both oral and inhaled corticosteroids have been associated with improvement in cough 2

Treatment Algorithm

1. First-line therapy (for most causes of dry cough):

   • Trial of inhaled corticosteroids with bronchodilators for 2-8 weeks 2

2. When to use oral corticosteroids:

   • For severe or refractory cough not responding to inhaled therapy
   • When rapid symptom relief is needed
   • For conditions with known steroid responsiveness (asthma, eosinophilic bronchitis)

3. Dosing recommendations:

   • Adults: Prednisone 40-60mg daily for 5-10 days 2
   • Children: 1-2mg/kg/day for 3-10 days 2
   • No tapering necessary for short courses 2

4. Follow-up therapy:

   • Transition to inhaled corticosteroids for maintenance therapy
   • Complete resolution of cough may require up to 8 weeks of treatment with inhaled corticosteroids 1

Specific Conditions and Considerations

Asthma and Cough Variant Asthma

Oral steroids are particularly effective for asthmatic cough. In one study, all patients with cough variant asthma responded to a diagnostic trial of prednisone 30mg daily within 1-2 weeks 3. For severe cases, oral steroid therapy (prednisone 40mg daily for 1 week) followed by inhaled therapy may be necessary 2.

Chronic Bronchitis

For chronic bronchitis, oral corticosteroids are not recommended for routine use but may be beneficial during acute exacerbations 2. Short-acting inhaled β-agonists and ipratropium bromide are preferred for regular management 2.

Sarcoidosis

In sarcoidosis-related cough, oral corticosteroids improve symptoms but require individualized risk-benefit assessment due to potential side effects and limited evidence of long-term benefit 2.

Important Caveats and Pitfalls

1. Potential side effects: Significant side effects can occur with prolonged use of oral corticosteroids, necessitating short courses only 2

2. Diagnostic considerations: Before initiating oral steroids, exclude other causes of cough such as:

   • Upper airway cough syndrome
   • Gastroesophageal reflux disease
   • Medication-induced cough (e.g., ACE inhibitors) 2

3. Inhaled steroid-induced cough: Some inhaled steroids may actually exacerbate cough due to components in the aerosol dispersant 2

4. Smoking: Smokers have decreased responsiveness to steroids, possibly due to persistent irritation and scarring 2

5. Assessment of airway inflammation: When available, assessment of airway inflammation (e.g., induced sputum) can identify patients who may benefit from more aggressive anti-inflammatory therapy 2

Evidence Quality

The evidence for oral corticosteroid use in dry cough varies by condition. The strongest evidence exists for asthma-related cough, with fair evidence for sarcoidosis and inflammatory bowel disease-related cough. The American College of Chest Physicians guidelines provide the most comprehensive recommendations, suggesting short courses of oral steroids for refractory cough, particularly when associated with asthma or eosinophilic airway inflammation 1.