What is the typical dosage of prednisone (corticosteroid) for upper respiratory issues?

Prednisone Dosage for Upper Respiratory Issues

For most upper respiratory tract infections in adults without underlying chronic lung disease, prednisone is not recommended and should not be used, as it does not reduce symptom duration or severity. 1

When Prednisone IS Indicated for Upper Respiratory Conditions

Postinfectious Cough (After Acute Respiratory Infection)

For severe paroxysms of postinfectious cough that adversely affects quality of life and persists despite other treatments, prescribe prednisone 30-40 mg daily for a short, finite period of time. 2

• This indication applies only after ruling out other common causes such as upper airway cough syndrome, asthma, or gastroesophageal reflux disease 2
• Consider this dosing when cough has persisted for 3-8 weeks following an acute respiratory infection 2
• Before initiating prednisone, first trial inhaled ipratropium, then inhaled corticosteroids if symptoms persist 2
• Reserve oral prednisone for cases where quality of life is significantly impacted and other measures have failed 2

COPD Exacerbation (If Applicable)

If the "upper respiratory issue" is actually a COPD exacerbation with increased dyspnea, cough, or sputum production:

• Prednisone 30-40 mg orally once daily for 5 days 3, 4
• Oral administration is strongly preferred over intravenous 3, 4
• Do not exceed 5-7 days of treatment, as longer courses increase adverse effects without additional benefit 3, 4
• Do not prescribe more than 200 mg total prednisone equivalents for the entire course 4

Asthma Exacerbation (If Applicable)

If the presentation involves wheezing, dyspnea, and bronchospasm:

• Prednisone 40-60 mg daily for 5-10 days 5
• Continue until peak expiratory flow reaches 70% of predicted or personal best 5
• No tapering is necessary for courses less than 7-10 days, especially if patient is on inhaled corticosteroids 5

When Prednisone Should NOT Be Used

Do not prescribe oral corticosteroids for uncomplicated acute upper respiratory tract infections or acute lower respiratory tract infections in adults without asthma. 1

• A high-quality randomized trial of 398 adults with acute lower respiratory tract infection found no reduction in cough duration (median 5 days in both groups) or symptom severity with prednisone 40 mg daily for 5 days 1
• The adjusted difference in symptom severity was not clinically meaningful (-0.20 points on a 0-6 scale) 1
• There is no role for antibiotics or corticosteroids in simple viral upper respiratory infections 2

Critical Clinical Pitfalls to Avoid

• Never use prednisone for routine viral upper respiratory infections - it provides no benefit and exposes patients to unnecessary adverse effects including hyperglycemia, weight gain, and insomnia 1
• Do not confuse postinfectious cough (3-8 weeks duration) with acute infection - prednisone may help the former but not the latter 2
• Always rule out bacterial sinusitis or pertussis before attributing prolonged cough to postinfectious causes, as these require specific antimicrobial therapy 2
• Avoid prolonged courses - if prednisone is indicated, limit to 5-10 days maximum for respiratory conditions 3, 4, 5

Monitoring and Follow-Up

• For postinfectious cough, assess response within 3-5 days; if no improvement, reconsider the diagnosis 2
• Monitor for hyperglycemia, particularly in patients with diabetes or prediabetes 3
• If cough persists beyond 8 weeks, diagnose as chronic cough and investigate other etiologies 2