When to use a steroid or an inhaler, such as albuterol, for flu symptoms?

When to Use Steroids or Inhalers for Flu Symptoms

For uncomplicated influenza, do not use systemic corticosteroids—they increase mortality and complications without benefit. Use a short-acting bronchodilator (albuterol) only if you develop wheezing or bronchospasm, not routinely for all flu symptoms. 1, 2, 3

Key Decision Points

If You Have Simple Flu Without Wheezing

• Avoid systemic steroids entirely for uncomplicated influenza, as they are associated with significantly higher mortality and increased risk of hospital-acquired infections 2, 3
• Do not use albuterol or other bronchodilators unless you develop actual wheezing or difficulty breathing 1
• Symptomatic treatment includes analgesics (acetaminophen or NSAIDs), nasal saline irrigation, and rest 1

If You Develop Wheezing or Breathing Difficulty

• Use a short-acting bronchodilator (albuterol) inhaler if you experience wheezing, chest tightness, or shortness of breath 4, 5
• Take 2-4 puffs of albuterol via metered-dose inhaler with spacer, or use nebulizer treatment (2.5-5 mg) 4
• If you have a history of asthma or COPD and are prescribed an inhaled bronchodilator, use it before any other inhaled medications 6

If Wheezing Persists After Initial Albuterol

• Add ipratropium bromide (500 mcg via nebulizer or 8 puffs via MDI) to your next albuterol treatment 5
• Repeat the combination every 20 minutes for up to 3 doses 5
• Seek immediate medical attention if symptoms worsen or you develop severe features: inability to speak in full sentences, respiratory rate >25/min, heart rate >110/min, confusion, or bluish discoloration 5

When Steroids Might Be Considered (Rare Situations)

Bacterial Superinfection

• Systemic steroids may be considered only if there is strong evidence of bacterial pneumonia complicating influenza (fever with purulent sputum, infiltrate on chest X-ray) 4, 1
• In this case, antibiotics are the primary treatment, with a possible short course of oral prednisone 30-40 mg daily for 10-14 days 4

Pre-existing Asthma or COPD Exacerbation

• If you have known asthma or COPD and experience an acute exacerbation triggered by flu, oral corticosteroids (prednisone 30-40 mg daily for 10-14 days) are appropriate 4
• This is treating the underlying lung disease exacerbation, not the flu itself 4

Critical Warnings

Bronchospasm Risk with Zanamivir

• If prescribed the antiviral zanamivir (Relenza), be aware it can cause serious bronchospasm, especially in people with asthma or COPD 6
• Have a fast-acting bronchodilator (albuterol) available before using zanamivir 6
• Stop zanamivir immediately and seek emergency care if you develop worsening breathing, chest tightness, or wheezing 6

Signs Requiring Emergency Care

• Seek immediate medical attention if you develop: severe shortness of breath, chest pain, confusion, inability to stay awake, bluish lips or face, or persistent high fever despite treatment 5, 6
• Stop any inhaled medications and call emergency services if you experience severe allergic reactions (facial swelling, throat tightness, severe rash) 6

Common Pitfalls to Avoid

• Do not request or accept systemic steroids for routine flu treatment—the evidence consistently shows harm, not benefit 2, 3
• Do not use albuterol "just in case" if you have no wheezing or breathing difficulty—it provides no benefit for typical flu symptoms 1
• Do not delay seeking medical care if breathing worsens, hoping home treatments will suffice 5
• If prescribed antivirals like oseltamivir (Tamiflu) or baloxavir, these work best when started within 48 hours of symptom onset, but they do not replace the need for bronchodilators if wheezing develops 7