What is the recommended dosing for prednisone (corticosteroid) in patients with bronchitis?

Prednisone Dosing for Bronchitis

For acute bronchitis in otherwise healthy adults, prednisone is not recommended as there is no evidence supporting its use and potential side effects outweigh benefits. 1

Acute Bronchitis vs. Chronic Bronchitis

Acute Bronchitis

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

Chronic Bronchitis

• For stable chronic bronchitis, long-term maintenance therapy with oral corticosteroids such as prednisone should not be used 2, 3
• For acute exacerbations of chronic bronchitis, a short course (10-15 days) of systemic corticosteroid therapy is recommended 2, 3

Recommended Prednisone Dosing for Acute Exacerbations of Chronic Bronchitis

For acute exacerbations of chronic bronchitis, a short course of prednisone at 0.5 mg/kg/day (typically 40 mg daily) for 5-7 days is recommended. 2, 3

• Systemic corticosteroids improve lung function (FEV1), oxygenation, and shorten recovery time and hospitalization duration 2
• A 2-week course of corticosteroids was equivalent to an 8-week course, suggesting shorter durations are preferable to minimize side effects 2, 3
• Oral prednisolone is equally effective to intravenous administration 2

Special Considerations

Bronchiectasis

• For bronchiectasis, inhaled corticosteroids have been studied but showed non-significant trends toward improved lung function 2
• Oral corticosteroids may be more effective in treating bronchial inflammation, but there have been no randomized controlled trials addressing clinical endpoints in patients with bronchiectasis 2

Sputum Eosinophilia

• Patients with chronic bronchitis who have sputum eosinophilia are more likely to respond favorably to steroid therapy 4
• Consider examining sputum for eosinophils before initiating therapy, as this may predict response 4

Treatment Algorithm

1. Confirm diagnosis: Distinguish between acute bronchitis and acute exacerbation of chronic bronchitis 1, 3

2. For acute bronchitis:

   • Do not prescribe prednisone 1
   • Consider symptomatic relief with central cough suppressants such as codeine or dextromethorphan 2, 1

3. For acute exacerbations of chronic bronchitis:

   • Start with short-acting bronchodilators (β-agonists or anticholinergics) 2
   • Add prednisone 40 mg daily for 5-7 days 2, 3
   • Consider antibiotics if bacterial infection is suspected (increased dyspnea, sputum volume, and purulence) 2

4. For stable chronic bronchitis:

   • Do not use oral corticosteroids for maintenance therapy 2, 3
   • Consider inhaled corticosteroids for patients with FEV1 <50% predicted or frequent exacerbations 3
   • Consider combination therapy with long-acting β-agonist plus inhaled corticosteroid for persistent symptoms 3

Common Pitfalls to Avoid

• Prescribing steroids for acute bronchitis based on the presence of wheezing or purulent sputum is not recommended 1
• Using steroids in hopes of shortening illness duration in acute bronchitis, when evidence shows no benefit 1
• Prolonged use of oral corticosteroids in chronic bronchitis can lead to significant side effects including osteoporosis, hyperglycemia, and immunosuppression 3
• Mistaking acute bronchitis for asthma exacerbation or pneumonia, both of which may benefit from steroid therapy 1