Steroids Are Not Recommended for 14-Day Bronchitis

Systemic corticosteroids are not justified in the treatment of acute bronchitis in healthy adults. 1

Understanding Acute Bronchitis vs. Chronic Bronchitis

Acute bronchitis is a self-limiting condition with a generally favorable course after about 10 days, although cough may persist longer 1
Acute bronchitis should be distinguished from acute exacerbations of chronic bronchitis, which do benefit from steroid therapy 1, 2

The French guidelines explicitly state that systemic corticosteroids are not justified for acute bronchitis in otherwise healthy adults 1
Purulent sputum during acute bronchitis is not associated with bacterial superinfection and does not justify steroid treatment 1
Short-term treatment with inhaled corticosteroids did not improve lung function or inflammatory parameters in patients with chronic bronchitis compared to placebo 3

For symptomatic relief, central cough suppressants such as codeine and dextromethorphan are recommended for short-term relief of coughing 1
Antibiotics should not be routinely prescribed for acute bronchitis in healthy adults 1
NSAIDs at an anti-inflammatory dose level are not justified for acute bronchitis 1

For acute exacerbations of chronic bronchitis, a short course (10-15 days) of systemic corticosteroid therapy is recommended 2
Systemic corticosteroids improve lung function (FEV1), oxygenation, and shorten recovery time in acute exacerbations of chronic bronchitis 2
A typical regimen for acute exacerbations of chronic bronchitis is prednisone at 0.5 mg/kg/day (typically 40 mg daily) for 5-7 days 1
For patients with chronic bronchitis and severe airflow limitation (FEV1 <50% predicted) or frequent exacerbations, inhaled corticosteroid therapy should be considered 2

Mistaking acute bronchitis for asthma exacerbation or pneumonia, both of which may benefit from steroid therapy 1
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
Continuing oral corticosteroids for long-term maintenance therapy in stable chronic bronchitis, as there is no evidence of benefit and significant risk of side effects 2

In patients with sputum eosinophilia, steroids may be beneficial - sputum examination revealing eosinophils is a good predictor of a favorable response to steroid therapy 4
For patients with chronic bronchitis who are prescribed inhaled steroids, regular instruction in inhaler technique is important as technique was judged insufficient in 27% of patients in one study 5
When steroids are prescribed, compliance should be monitored as non-compliance was found in 46% of patients with airway obstruction on inhaled steroid therapy 5