What is the recommended dose of corticosteroids, such as prednisolone, for patients with bronchitis?

Corticosteroid Dosing for Bronchitis

For patients with acute exacerbations of chronic bronchitis, a short course (10-15 days) of systemic corticosteroid therapy is recommended, with IV therapy for hospitalized patients and oral therapy for ambulatory patients. 1, 2

Acute Exacerbations of Chronic Bronchitis

• For acute exacerbations, prednisolone can be administered at 1-2 mg/kg/day for 10-15 days, with dosing individualized based on disease severity 2, 3
• Systemic corticosteroids improve lung function (FEV1) and reduce treatment failure rates during acute exacerbations 1, 2
• A 2-week course has been shown to be equivalent to an 8-week course, suggesting shorter durations are preferable to minimize side effects 1, 2
• The initial dose of prednisolone may vary from 5 to 60 mg per day depending on the specific disease entity and severity being treated 3

Stable Chronic Bronchitis

• For stable chronic bronchitis, long-term maintenance therapy with oral corticosteroids such as prednisone should NOT be used due to lack of evidence for benefit and high risk of serious side effects 1, 2
• A four-week trial with inhaled steroids did not significantly improve airway inflammation in patients with chronic bronchitis compared to placebo 4
• Oral steroids at doses less than 10-15 mg prednisolone show no evidence to support long-term use, while higher doses (≥30 mg) may improve lung function over short periods but carry significant adverse effects 5

Treatment Based on Disease Severity

• For patients with chronic bronchitis and an FEV1 of <50% predicted or those with frequent exacerbations, inhaled corticosteroid therapy should be offered 1, 2
• In stable patients with chronic bronchitis, treatment with a long-acting β-agonist combined with an inhaled corticosteroid should be offered to control chronic cough 1
• Patients with sputum eosinophilia are more likely to respond favorably to steroid therapy (7 of 9 patients with sputum eosinophilia responded to steroids in one study) 6

Common Pitfalls and Considerations

• Mistaking acute bronchitis for an exacerbation of chronic bronchitis can lead to inappropriate steroid use - systemic corticosteroids are not justified in the treatment of acute bronchitis in healthy adults 7
• Mucolytic agents may be considered as an alternative or adjunct therapy for patients with chronic bronchitis, especially those not already receiving inhaled corticosteroids 8
• Corticosteroids can cause significant side effects with prolonged use, including hyperglycemia, adrenal suppression, osteoporosis, and immunosuppression 2, 5

Treatment Algorithm for Corticosteroid Use in Bronchitis

1. For acute exacerbations of chronic bronchitis:

   • Start with prednisolone 30-40 mg daily for 10-15 days 1, 2
   • IV therapy for hospitalized patients, oral therapy for ambulatory patients 1, 2
   • No need to taper dose for short-term therapy 2

2. For stable chronic bronchitis:

   • Avoid long-term oral corticosteroids 1, 5
   • Consider inhaled corticosteroids only if FEV1 <50% predicted or frequent exacerbations 1
   • Consider combination therapy with long-acting β-agonist plus inhaled corticosteroid for persistent symptoms 1, 2