Dexamethasone is NOT Recommended for Acute Bronchitis in Adults
For acute bronchitis in otherwise healthy adults, systemic corticosteroids including dexamethasone should not be used—they provide no clinical benefit and are explicitly not justified according to current guidelines. 1
Why Steroids Don't Work for Acute Bronchitis
- Acute bronchitis in healthy adults follows a self-limited course resolving in approximately 10 days, though cough may persist longer, and corticosteroids do not alter this natural history 1
- Even purulent sputum during acute bronchitis does not indicate bacterial superinfection and does not justify steroid treatment 1
- Multiple guidelines from the Infectious Diseases Society of America, European Respiratory Society, and French national guidelines all explicitly recommend against corticosteroid use in uncomplicated acute bronchitis 1
Critical Distinction: Acute Exacerbation of CHRONIC Bronchitis
If your patient has chronic bronchitis (cough and sputum production on most days for at least 3 months in 2 consecutive years) and is experiencing an acute exacerbation, then steroids ARE indicated. 2
For Acute Exacerbations of Chronic Bronchitis:
Recommended regimen: Prednisone 40 mg daily (or 0.5 mg/kg/day) for 5-7 days 1
- Alternative duration cited in guidelines: 10-15 days of systemic corticosteroid therapy 2
- This improves lung function (FEV1), oxygenation, shortens recovery time, and reduces hospitalization duration 1
- Both IV therapy for hospitalized patients and oral therapy for ambulatory patients are effective 2
Dexamethasone Equivalent Dosing (if you must use it instead of prednisone):
Based on FDA labeling, dexamethasone dosing for acute allergic/inflammatory conditions: 3
- Initial dose: 4-8 mg intramuscularly on day 1
- Then taper: 0.75 mg tablets, 4 tablets divided over days 2-3, then 2 tablets divided on day 4, then 1 tablet on days 5-6
- Total duration: approximately 5-7 days
However, prednisone remains the preferred agent as it has the evidence base specifically for bronchitis exacerbations. 1
Common Pitfalls to Avoid
- Don't confuse acute bronchitis with asthma exacerbation: If the patient has wheezing and responds to bronchodilators, consider asthma rather than simple bronchitis—asthma does benefit from steroids 2
- Don't prescribe steroids hoping to shorten illness duration: Evidence clearly shows no benefit in acute bronchitis 1
- Don't use steroids based on purulent sputum alone: This is not an indication for steroid therapy in acute bronchitis 1
- Don't mistake acute bronchitis for pneumonia: Obtain chest X-ray if concerned about pneumonia, which may warrant different treatment 2
What TO Use for Acute Bronchitis Symptom Relief
- For troublesome cough: Codeine or dextromethorphan for short-term symptomatic relief 2
- For wheezing in select patients: β2-agonist bronchodilators may help if wheezing is present, though not routinely recommended 2
- Avoid: Antibiotics (not indicated), expectorants (no evidence of benefit), theophylline (should not be used) 2
Long-term Steroid Use Warning
For patients with stable chronic bronchitis, long-term maintenance therapy with oral corticosteroids like prednisone should never be used—there is no evidence it improves cough and sputum production, and the risks of serious side effects are high 2