Are steroids beneficial for bronchitis?

Steroids for Bronchitis: Evidence-Based Recommendations

For acute exacerbations of chronic bronchitis, a short course (10-15 days) of systemic corticosteroid therapy is beneficial and should be given; both IV therapy for hospitalized patients and oral therapy for ambulatory patients have proven effective. 1

Acute Exacerbations vs. Stable Chronic Bronchitis

Acute Exacerbations of Chronic Bronchitis:

• Systemic corticosteroids (oral or IV) for 10-15 days are recommended with substantial evidence supporting their use 1
• Corticosteroids improve treatment outcomes including lung function (FEV1) and reduce treatment failure rates 1
• In the largest trial, a 2-week course was equivalent to an 8-week course, suggesting shorter durations are preferable to minimize side effects 1

Stable Chronic Bronchitis:

• Oral corticosteroids should NOT be used for long-term maintenance therapy in stable chronic bronchitis 1
• There is no evidence of benefit for oral corticosteroids in stable patients, and the well-known side effects preclude their long-term use 1
• Short-term treatment with inhaled corticosteroids alone does not significantly improve inflammatory parameters compared to placebo in patients with chronic bronchitis 2

Specific Recommendations Based on Disease Severity

• For patients with severe or very severe airflow obstruction (FEV1 <50% predicted) or frequent exacerbations of chronic bronchitis, inhaled corticosteroid therapy should be offered 1
• Combined therapy with a long-acting β-agonist and an inhaled corticosteroid has been shown to reduce exacerbation rates and cough in long-term trials 1
• For patients with chronic bronchitis without severe airflow limitation, bronchodilators (short-acting β-agonists or ipratropium bromide) should be the first-line therapy 1

Predictors of Steroid Response

• Sputum eosinophilia is a good predictor of favorable response to steroid therapy in chronic bronchitis 3
• Blood eosinophilia alone is not a reliable predictor of steroid response 3

Important Caveats and Potential Pitfalls

• Corticosteroids can cause significant side effects, especially with prolonged use, including:

  • Growth suppression in children
  • Osteoporosis
  • Hyperglycemia
  • Immunosuppression
  • Adrenal suppression 4

• For acute exacerbations, bronchodilator therapy should be administered first (short-acting β-agonists or anticholinergic bronchodilators) 1

• Theophylline should NOT be used for treatment of acute exacerbations of chronic bronchitis 1

• Expectorants have not shown evidence of effectiveness for either stable chronic bronchitis or acute exacerbations 1

Treatment Algorithm

1. For acute exacerbations:

   • Start with short-acting bronchodilators (β-agonists or anticholinergics) 1
   • Add systemic corticosteroids for 10-15 days (oral for outpatients, IV for hospitalized patients) 1
   • Consider antibiotics if bacterial infection is suspected
   • Avoid theophylline and expectorants 1

2. For stable chronic bronchitis:

   • Use short-acting bronchodilators as first-line therapy 1
   • For patients with FEV1 <50% or frequent exacerbations: add inhaled corticosteroids 1
   • Consider combination therapy with long-acting β-agonist plus inhaled corticosteroid for persistent symptoms 1
   • Avoid long-term oral corticosteroids 1