Do steroids affect a common cold in a patient with asthma (Asthma) or Chronic Obstructive Pulmonary Disease (COPD)?

Steroids and the Common Cold in Asthma/COPD Patients

Steroids do not treat the common cold itself, but patients with asthma or COPD should continue their prescribed inhaled corticosteroids during a cold, as discontinuation risks severe exacerbations that far outweigh any theoretical concerns about viral clearance. 1, 2

For Patients with Asthma

Continue maintenance inhaled corticosteroids (ICS) during common colds without interruption. 2, 3

• Patients on budesonide/formoterol maintenance and reliever therapy experience 36-52% fewer severe cold-related exacerbations compared to other regimens, demonstrating the protective effect of ICS during viral infections. 4

• The ICS component specifically reduces cold-related exacerbations in asthma patients, making continuation essential during upper respiratory infections. 4

• Do not add or increase oral corticosteroids for a simple cold in asthma patients unless there is objective evidence of an asthma exacerbation (increased breathlessness, wheezing, chest tightness, or decreased peak flow). 5

• If asthma symptoms worsen during a cold (increased cough, wheeze, or breathlessness), treat as an asthma exacerbation with increased bronchodilators and consider a short course of oral corticosteroids (typically prednisone 40 mg daily for 5-7 days). 5, 6

For Patients with COPD

Continue maintenance inhaled corticosteroids during common colds, but do not add systemic steroids unless there is a true COPD exacerbation. 7, 1

Distinguishing a Cold from COPD Exacerbation

A COPD exacerbation requiring systemic steroids must include at least two of the following three criteria (not just cold symptoms): 7

• Increased breathlessness beyond baseline
• Increased sputum volume
• Development of purulent sputum (change in color)

If only experiencing typical cold symptoms (runny nose, sore throat, mild cough) without meeting exacerbation criteria, do not prescribe oral corticosteroids. 1

Treatment Algorithm for COPD Patients with Respiratory Symptoms

1. Simple cold symptoms only (no change in baseline dyspnea, sputum volume, or purulence):

   • Continue maintenance ICS/LABA therapy
   • Symptomatic treatment only
   • No systemic steroids 1

2. COPD exacerbation (≥2 of the 3 cardinal symptoms above):

   • Add or increase bronchodilators first 7
   • Prescribe oral corticosteroids: prednisone 30-40 mg daily for 5-7 days (not longer) 7, 8, 9
   • Consider antibiotics if purulent sputum present 7

3. Maintenance therapy considerations:

   • Patients with FEV1 <50% predicted or frequent exacerbations should be on inhaled corticosteroids combined with long-acting bronchodilators 9, 10
   • Never use long-term oral corticosteroids for stable COPD 9

Critical Safety Points

The concern about steroids impairing viral clearance is vastly outweighed by the risk of severe asthma or COPD exacerbations from stopping maintenance therapy. 2, 3

• Stopping inhaled corticosteroids during a cold can precipitate life-threatening exacerbations in both asthma and COPD patients. 2, 3

• Short-term systemic corticosteroids (5-7 days) carry acceptable risks (hyperglycemia, insomnia, weight gain) when used appropriately for true exacerbations. 1

• The number needed to treat with ICS/LABA to prevent one moderate-to-severe exacerbation is only 4 patients per year, demonstrating substantial benefit. 10

Common Pitfalls to Avoid

• Do not prescribe systemic steroids for acute bronchitis or simple colds in otherwise healthy adults—this exposes patients to harm without benefit. 1

• Do not mistake a common cold for an asthma or COPD exacerbation—look for objective worsening of baseline respiratory status, not just viral URI symptoms. 5, 1

• Do not stop maintenance inhaled corticosteroids during a cold due to misplaced concerns about immune suppression—the anti-inflammatory protection is essential. 2, 3

• Do not prescribe prolonged courses of oral steroids (>7 days) for COPD exacerbations—2 weeks is equivalent to 8 weeks in efficacy, and shorter courses minimize side effects. 9