What is the suggested dexamethasone (corticosteroid) course for treating bronchitis?

Dexamethasone for Bronchitis: Not Recommended

Dexamethasone and other corticosteroids should NOT be used for acute bronchitis in otherwise healthy patients, as there is no evidence of benefit and guidelines explicitly recommend against their use. 1

Critical Distinction: Type of Bronchitis Matters

The answer depends entirely on which type of bronchitis you're treating:

Acute Bronchitis (Simple)

• No corticosteroids indicated - French and European guidelines explicitly state systemic corticosteroids are not justified in acute bronchitis in healthy adults 1
• The illness is self-limiting, resolving spontaneously in approximately 10 days 1
• Purulent sputum does NOT indicate bacterial infection or justify steroid treatment 1
• Common pitfall: Prescribing steroids based on wheezing or purulent sputum appearance - these are not indications for steroid therapy 1

Acute Exacerbations of Chronic Bronchitis

For acute exacerbations, systemic corticosteroids ARE recommended:

• Prednisone 40 mg daily (or 0.5 mg/kg/day) for 10-15 days is the evidence-based regimen 2, 3, 1
• Both IV therapy (hospitalized patients) and oral therapy (ambulatory patients) are effective 2, 3
• A 2-week course is equivalent to an 8-week course, so shorter duration is preferred to minimize side effects 2, 3
• This improves lung function (FEV1), reduces treatment failure rates, and shortens recovery time 3, 1

Stable Chronic Bronchitis

• Long-term oral corticosteroids should NOT be used - no evidence of benefit and significant side effect risks 2, 3
• Inhaled corticosteroids should be offered for patients with FEV1 <50% predicted or frequent exacerbations 2, 3
• Combined long-acting β-agonist plus inhaled corticosteroid reduces exacerbation rates and cough 2, 3

Bronchiolitis (Infants)

• Corticosteroids should NOT be used routinely in bronchiolitis management 2
• Multiple high-quality trials show no benefit: A large multicenter RCT of 600 infants found dexamethasone 1 mg/kg did not reduce hospital admissions (39.7% vs 41.0% placebo) or improve respiratory status 4
• Single-dose dexamethasone provides no advantage over placebo in hospitalization rates or respiratory outcomes 5, 6

Treatment Algorithm

Step 1: Identify the specific condition

• Acute bronchitis in healthy adult → No steroids 1
• Acute exacerbation of chronic bronchitis (increased cough, sputum, purulence, dyspnea in patient with known chronic bronchitis) → Systemic steroids indicated 2
• Stable chronic bronchitis → Consider inhaled steroids only if FEV1 <50% or frequent exacerbations 2, 3
• Bronchiolitis in infant → No steroids 2, 4

Step 2: For acute exacerbations of chronic bronchitis

• Start short-acting bronchodilators (β-agonists or anticholinergics) 3
• Add prednisone 40 mg daily (or 0.5 mg/kg/day) for 10-15 days 2, 3, 1
• Consider antibiotics only if bacterial infection suspected 3

Step 3: For stable chronic bronchitis with persistent symptoms

• First-line: Short-acting bronchodilators 3
• If FEV1 <50% or frequent exacerbations: Add inhaled corticosteroid 2, 3
• For persistent symptoms: Combination long-acting β-agonist plus inhaled corticosteroid 2, 3

Key Caveats

• Do not confuse acute bronchitis with asthma exacerbation - the latter does benefit from steroids 1
• Sputum eosinophilia (not blood eosinophilia) may predict steroid responsiveness in chronic bronchitis, though this is rarely checked in routine practice 7
• Side effects of systemic corticosteroids include hyperglycemia, immunosuppression, and osteoporosis with prolonged use 3
• The evidence base for dexamethasone specifically is limited; most guidelines reference prednisone for chronic bronchitis exacerbations 2, 3, 1