Are steroids recommended for treating acute bronchitis?

Steroids for Acute Bronchitis

Corticosteroids should not be used in the treatment of acute bronchitis in healthy adults as there is no evidence of benefit and potential for harm. 1

Evidence Against Steroid Use in Acute Bronchitis

• The French guidelines explicitly state that systemic corticosteroids are not justified in the treatment of acute bronchitis in healthy adults 1
• The clinical course of acute bronchitis is generally spontaneously favorable after about 10 days, although cough may persist longer 1
• Purulent sputum during acute bronchitis in healthy adults is not associated with bacterial superinfection and does not justify steroid treatment 1

Distinguishing Acute Bronchitis from Other Conditions

• It's important to distinguish acute bronchitis from conditions that might benefit from steroids:
  • Acute exacerbations of chronic bronchitis do benefit from a short course (10-15 days) of systemic corticosteroid therapy 2
  • For patients with an acute exacerbation of chronic bronchitis, both IV therapy in hospitalized patients and oral therapy for ambulatory patients have proven effective 2

Treatment Recommendations for Acute Bronchitis

• As a rule, antibiotics should not be prescribed in the treatment of acute bronchitis in healthy adults 1
• NSAIDs at an anti-inflammatory dose level are not justified for acute bronchitis 1
• For symptomatic relief, central cough suppressants such as codeine and dextromethorphan are recommended for short-term relief of coughing in patients with chronic bronchitis 1

Special Considerations

• In bronchiolitis (which is different from acute bronchitis), corticosteroid medications should not be used routinely in management 1
• Systematic reviews and meta-analyses of RCTs involving close to 1200 children with viral bronchiolitis have not shown sufficient evidence to support the use of steroids in this illness 1

Chronic Bronchitis Considerations

• For stable patients with chronic bronchitis, long-term maintenance therapy with oral corticosteroids such as prednisone should not be used; there is no evidence that it improves cough and sputum production, and the risks of serious side effects are high 1
• For stable patients with chronic bronchitis and an FEV1 of < 50% predicted or for those with frequent exacerbations, inhaled corticosteroid therapy should be offered 1, 2

Common Pitfalls

• Mistaking acute bronchitis for asthma exacerbation or pneumonia, both of which may benefit from steroid therapy 2
• Prescribing steroids for acute bronchitis based on the presence of wheezing or purulent sputum, which are not indications for steroid therapy in this condition 1
• Using steroids in hopes of shortening illness duration, when evidence shows no benefit for this purpose in acute bronchitis 1

Remember that acute bronchitis is typically a self-limited condition, and the focus should be on symptomatic relief rather than interventions that have not demonstrated benefit and may cause harm.