Can steroids be given to patients with cold and cough, particularly those with underlying respiratory conditions such as asthma (Asthma) or Chronic Obstructive Pulmonary Disease (COPD)?

Steroids for Cold and Cough

Steroids should NOT be given for simple cold and cough (acute bronchitis) in otherwise healthy adults, but ARE indicated for patients with underlying asthma or COPD experiencing exacerbations. 1

Simple Cold and Cough (Acute Bronchitis)

• Systemic corticosteroids are explicitly not justified for acute bronchitis in healthy adults. 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 and does not justify steroid treatment. 1
• Common pitfall: Prescribing steroids based on wheezing or purulent sputum appearance—these are NOT indications for steroid therapy in uncomplicated acute bronchitis. 1
• Another pitfall: Using steroids hoping to shorten illness duration—evidence shows no benefit for this purpose. 1

Patients with Underlying Asthma

For asthma patients presenting with cough, steroids are the cornerstone of treatment:

• Initial therapy should include inhaled corticosteroids combined with bronchodilators. 2
• For severe or refractory asthmatic cough, a short course (1-2 weeks) of oral corticosteroids (e.g., prednisone 40 mg daily) followed by inhaled corticosteroids is recommended. 2
• The FDA-approved indication for prednisolone specifically includes asthma and acute exacerbations of COPD. 3
• Critical distinction: You must differentiate between simple acute bronchitis and asthma exacerbation—asthma benefits substantially from steroid therapy while acute bronchitis does not. 1, 4

Dosing for Asthma

• Adults: Prednisone 40 mg daily for 5-7 days for acute exacerbations. 5
• Pediatric patients: 1-2 mg/kg/day in divided doses, or 60 mg/m²/day for 4 weeks in nephrotic syndrome protocols. 3
• Inhaled corticosteroids should be continued long-term for maintenance. 2

Patients with COPD/Chronic Bronchitis

The indication for steroids depends critically on whether the patient has stable disease versus an acute exacerbation:

Acute Exacerbations of Chronic Bronchitis

• Systemic corticosteroids ARE recommended for acute exacerbations. 1, 5
• Standard regimen: Prednisone 40 mg daily (or 0.5 mg/kg/day) for 5-7 days, which can be given orally for outpatients or IV for hospitalized patients. 1, 5
• This improves lung function (FEV₁), oxygenation, shortens recovery time, and reduces hospitalization duration. 1, 5
• A 2-week course is equivalent to an 8-week course, so shorter durations (5-7 days) are preferable to minimize side effects. 5

Stable Chronic Bronchitis

• Long-term oral corticosteroids should NOT be used for maintenance therapy in stable chronic bronchitis—there is no evidence of benefit and well-known side effects preclude their use. 5
• For patients with FEV₁ <50% predicted or frequent exacerbations, inhaled corticosteroids (preferably combined with long-acting β-agonists) should be offered as they reduce exacerbation rates. 5
• Short-acting bronchodilators should be first-line therapy for those without severe airflow limitation. 5

Algorithmic Approach

Step 1: Determine the underlying condition

• Simple cold/acute bronchitis in healthy adult → NO steroids 1
• Known asthma with cough → YES, inhaled ± oral steroids 2
• Known COPD with acute exacerbation → YES, oral/IV steroids for 5-7 days 1, 5
• Known COPD, stable → NO oral steroids; consider inhaled steroids if FEV₁ <50% or frequent exacerbations 5

Step 2: If uncertain diagnosis

• Look for history of chronic respiratory disease, prior spirometry, or smoking history (>10 pack-years suggests possible COPD). 4
• Consider undiagnosed asthma if patient has atopy, nocturnal symptoms, or exercise-induced symptoms. 4
• Obtain chest X-ray to exclude pneumonia, which may have different steroid indications. 4

Step 3: If prescribing steroids

• For asthma exacerbation: Prednisone 40 mg daily for 5-7 days, then transition to inhaled corticosteroids. 2, 5
• For COPD exacerbation: Prednisone 40 mg daily for 5-7 days (no taper needed after short course). 1, 5
• For stable COPD with severe disease: Initiate inhaled corticosteroid/long-acting β-agonist combination. 5

Critical Caveats

• Never mistake acute bronchitis for asthma or COPD exacerbation—this is the most common error leading to inappropriate steroid use. 1, 4
• Intranasal steroids are ineffective for common cold symptoms including cough. 2
• For upper airway symptoms with cough, a 1-month trial of topical nasal corticosteroid may be considered, but this addresses post-nasal drip, not the cold itself. 2
• In patients with idiopathic pulmonary fibrosis or sarcoidosis, inhaled corticosteroids should NOT be routinely prescribed for chronic cough. 2
• Corticosteroids can cause significant side effects including immunosuppression, hyperglycemia, and osteoporosis, particularly with prolonged use. 5