Steroid Dosing for Bronchitis
Steroids should NOT be used for acute bronchitis in otherwise healthy adults, as they provide no clinical benefit and expose patients to unnecessary medication risks. 1
Critical Distinction: Type of Bronchitis Matters
The answer depends entirely on which type of bronchitis you're treating:
Acute Bronchitis (Healthy Adults)
- Do not prescribe systemic corticosteroids - they are explicitly not justified according to French and European guidelines 1
- The clinical course is self-limited, resolving spontaneously after approximately 10 days (though cough may persist longer) 1
- Purulent sputum does NOT indicate bacterial superinfection or justify steroid treatment 1
- Common pitfall: Prescribing steroids based on wheezing or purulent sputum appearance, which are not indications for steroid therapy 1
Acute Exacerbations of Chronic Bronchitis (COPD Patients)
This is where steroids ARE indicated:
- Prednisone 30-40 mg orally once daily for 5 days is the evidence-based regimen 2
- Alternative dosing: 0.5 mg/kg/day (typically 40 mg daily) for 5-7 days 1
- Oral prednisone is strongly preferred over IV methylprednisolone - equivalent outcomes with fewer adverse effects 2
- Benefits include improved lung function (FEV1), better oxygenation, shortened recovery time, and reduced hospitalization duration 1, 3
- Treatment failure rates drop dramatically (odds ratio 0.01 vs placebo) 2
Clinical pearl: Consider point-of-care blood eosinophil count - levels ≥2% predict better response to corticosteroid therapy 2
Viral Bronchiolitis (Infants)
- Corticosteroids should NOT be used routinely 4, 1
- Meta-analyses of nearly 1,200 children showed no significant benefit in length of stay, clinical scores, or respiratory parameters 4
- Neither systemic nor inhaled corticosteroids alter the disease course 4, 5
Stable Chronic Bronchitis (Maintenance Therapy)
- Long-term oral corticosteroids (like prednisone) should NOT be used for maintenance 1
- Inhaled corticosteroids combined with long-acting β-agonists should be offered for symptom control 4
- For patients with FEV1 <50% predicted or frequent exacerbations, inhaled corticosteroid therapy is recommended 4
Avoiding Common Errors
Critical pitfall: Mistaking acute bronchitis for asthma exacerbation or pneumonia - these conditions DO benefit from steroids, but acute bronchitis does not 1
Avoid methylprednisolone dose packs for COPD exacerbations - they provide insufficient total corticosteroid dose compared to evidence-based regimens 2
Monitor diabetic patients receiving systemic steroids with blood glucose checks at least twice daily (hyperglycemia odds ratio 2.79) 2
Post-Treatment Management for COPD Exacerbations
After completing the 5-day prednisone course, initiate or optimize inhaled corticosteroid/long-acting β-agonist combination therapy to maintain lung function improvements and prevent future exacerbations 2