From the Guidelines
Prednisone may be considered for post-viral cough or acute bronchitis in adult patients with severe paroxysms of cough, but only when other common causes of cough have been ruled out and the cough persists despite other treatments, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.
Key Considerations
- The optimal treatment for postinfectious cough is not known, but therapy with antibiotics has no role as the cause is not bacterial infection 1.
- A trial of inhaled ipratropium may be considered to attenuate the cough, and inhaled corticosteroids may be considered when the cough adversely affects the patient's quality of life and persists despite use of inhaled ipratropium 1.
- For severe paroxysms of postinfectious cough, prednisone (30-40 mg per day) may be prescribed for a short, finite period of time, but this should be done with caution and under the guidance of a healthcare provider due to potential side effects 1.
Potential Side Effects and Risks
- Corticosteroids like prednisone have potential side effects including increased blood sugar, mood changes, sleep disturbances, and reduced immune function.
- Self-medication with prednisone is not recommended as it requires proper medical assessment and monitoring.
Recommendations for Practice
- For most uncomplicated post-viral coughs, supportive care with rest, hydration, and over-the-counter cough suppressants is usually sufficient.
- Antibiotics are not effective for viral infections.
- The decision to use prednisone should be made by a healthcare provider who can evaluate the patient's specific symptoms, medical history, and the potential benefits versus risks.
From the Research
Effectiveness of Prednisone for Post-Viral Cough/Acute Bronchitis
- The effectiveness of prednisone for post-viral cough/acute bronchitis is not directly addressed in the provided studies, but some studies discuss the use of corticosteroids for similar conditions 2, 3, 4.
- A study on oral corticosteroids for post-infectious cough in adults is ongoing, and its results may provide evidence on the effectiveness of corticosteroids for this condition 2.
- A study on the management of post-infective cough using inhaled ipratropium and salbutamol found that this combination can effectively reduce post-viral cough, but it does not involve prednisone 5.
- Another study found that oral prednisolone during the acute phase of RSV bronchiolitis is not effective in preventing post-bronchiolitis wheezing or asthma at the mean age of 5 years, which may be relevant to the use of prednisone for post-viral cough/acute bronchitis 3.
- Inhaled corticosteroids have been found to not reduce recurrent wheeze or asthma in patients with bronchiolitis, which may be related to the use of prednisone for post-viral cough/acute bronchitis 4.
Pathogenesis and Therapeutic Options
- Post-infectious cough is a common symptom associated with common colds and/or upper respiratory tract infection, and its pathogenesis is not fully understood 6.
- Current therapeutic options for post-infectious cough are little or only moderately effective, and there is a need for more effective treatments 6.
- The use of corticosteroids, such as prednisone, may be considered for post-viral cough/acute bronchitis, but its effectiveness is not well established 2, 3, 4.