From the Guidelines
Steroids are not recommended for routine treatment of acute bronchitis in immunocompetent adult outpatients. According to the Chest expert panel report 1, there is no suggestion for the routine prescription of inhaled corticosteroids or oral corticosteroids for acute bronchitis. The focus should be on symptomatic treatment and monitoring for potential complications.
Key Points to Consider
- The initial clinical evaluation is crucial in the longitudinal care of patients with acute bronchitis, as some cases may be related to underlying conditions such as mild asthma 1.
- Targeted investigations, including chest x-ray, sputum for microbial culture, and inflammatory markers like CRP, should be considered if the acute bronchitis persists or worsens 1.
- Antibiotic therapy should only be considered if a complicating bacterial infection is thought likely 1.
- Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis), should be taken into account when managing acute bronchitis 1.
Treatment Approach
- Symptomatic treatment, including rest, adequate hydration, and over-the-counter medications like acetaminophen or NSAIDs for fever and discomfort, is recommended.
- Inhaled bronchodilators, such as albuterol, may be used for wheezing or shortness of breath.
- Systemic corticosteroids, like prednisone, should be reserved for patients with underlying conditions, such as asthma or COPD exacerbations, where the benefits outweigh the potential side effects 1.
From the Research
Acute Bronchitis and Steroids
- The use of steroids in acute bronchitis is not explicitly mentioned in most of the studies provided 2, 3, 4, 5.
- However, a study on bronchiolitis in children under 2 years old found that combined dexamethasone and adrenaline reduced admissions on day 7 6.
- There is no direct evidence to support the use of steroids in acute bronchitis, but some studies suggest that they may be beneficial in certain cases, such as in combination with other treatments 6.
- The majority of acute bronchitis cases are caused by viruses, and antibiotics are generally not indicated for treatment 2, 3, 4.
- The use of steroids in acute bronchitis may be considered in specific cases, but more research is needed to determine their effectiveness and safety in this context.
Treatment of Acute Bronchitis
- The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective, and the U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years 2.
- Antibiotics may have a modest beneficial effect in some patients, such as frail, elderly people with multimorbidity, but the magnitude of this benefit needs to be considered in the broader context of potential side effects and increased resistance to respiratory pathogens 3.
- Some strategies, like the use of rapid tests, delayed prescribing of antibiotics, and the use of leaflets for patients, have been associated with a reduction in unnecessary antibiotic utilization 4.