When are steroids indicated for patients with bronchitis (Chronic Obstructive Pulmonary Disease - COPD)?

Steroids for Bronchitis in COPD

For acute exacerbations of chronic bronchitis (COPD), give a short course of systemic corticosteroids (10-15 days of oral prednisone 40 mg daily or IV equivalent); for stable chronic bronchitis, do NOT use oral corticosteroids for maintenance therapy. 1, 2

Acute Exacerbations of Chronic Bronchitis

Systemic corticosteroids are strongly recommended for acute exacerbations with Grade A evidence. 1

• Administer oral prednisone 0.5 mg/kg/day (typically 40 mg daily) for ambulatory patients 3
• Use IV corticosteroids for hospitalized patients 1, 2
• Duration should be 10-15 days (not longer) 1, 2
• A 2-week course is equivalent to an 8-week course, so shorter durations minimize side effects 2

Clinical benefits include:

• Improved lung function (FEV1 increases by approximately 120 ml within 6-72 hours) 4
• Reduced treatment failure rates 2, 4
• Improved oxygenation and shortened recovery time 3
• Shortened hospitalization duration 3

Treatment algorithm for acute exacerbations: 2, 3

1. Start short-acting bronchodilators (β-agonists or anticholinergics) 1
2. Add systemic corticosteroids for 10-15 days 1
3. Consider antibiotics if bacterial infection is suspected 2

Stable Chronic Bronchitis

Oral corticosteroids should NOT be used for long-term maintenance therapy. 1, 2, 3

• No evidence of benefit for cough or sputum production 1
• Significant risk of serious side effects (osteoporosis, hyperglycemia, immunosuppression, adrenal suppression) 2, 5
• Grade E/D recommendation against long-term oral steroid use 1

Instead, use inhaled corticosteroids in specific situations: 1, 2

• For patients with FEV1 <50% predicted 1, 2
• For patients with frequent exacerbations 1, 2
• Combined with long-acting β-agonist for better control of chronic cough 1, 2

Treatment algorithm for stable chronic bronchitis: 2

1. First-line: Short-acting bronchodilators (β-agonists or ipratropium bromide) 1, 2
2. Add inhaled corticosteroids if FEV1 <50% or frequent exacerbations 1, 2
3. Consider combination therapy (long-acting β-agonist + inhaled corticosteroid) for persistent symptoms 1, 2

Critical Distinction: Acute Bronchitis vs. Chronic Bronchitis

Do NOT use steroids for acute bronchitis in otherwise healthy adults. 3

• Acute bronchitis is self-limited (resolves in ~10 days) and does not benefit from steroids 3
• Purulent sputum does NOT indicate bacterial infection or need for steroids 3
• Common pitfall: Mistaking acute bronchitis for asthma exacerbation or COPD exacerbation 3

Common Pitfalls to Avoid

• Do not prescribe long-term oral steroids for stable COPD - no benefit and significant harm 1, 5
• Do not use steroids for acute bronchitis in healthy adults - this is a different condition from chronic bronchitis exacerbations 3
• Do not extend steroid courses beyond 2 weeks for exacerbations - no additional benefit and increased side effects 2
• Do not use theophylline during acute exacerbations - it is ineffective and potentially harmful 1

Monitoring for Adverse Effects

When using systemic corticosteroids, monitor for: 2, 5

• Hyperglycemia (increased blood glucose) 2, 5
• Adrenal suppression 2, 5
• Osteoporosis (reduced serum osteocalcin) 2, 5
• Immunosuppression 2