What is the recommended dose of prednisone (corticosteroid) for an adult patient with intercostal muscle strain from coughing, considering their past medical history, demographics, and current health status, including any underlying respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD)?

Prednisone Should Not Be Used for Intercostal Muscle Strain from Coughing

Intercostal muscle strain is a musculoskeletal injury that does not respond to corticosteroids, and prednisone has no role in its treatment. The evidence provided addresses cough management and respiratory conditions, not musculoskeletal injuries.

Why Prednisone Is Not Indicated

• Intercostal muscle strain is a mechanical soft tissue injury caused by overuse or trauma to the muscles between the ribs, and corticosteroids do not accelerate healing of muscle strains or reduce pain in this context.

• The provided guidelines address cough management, not musculoskeletal pain. The Thorax guidelines discuss corticosteroids for eosinophilic airway inflammation and asthma-related cough 1, which are fundamentally different conditions than muscle strain.

• Prednisone for post-infectious cough is reserved for severe paroxysms (30-40 mg daily for 5-10 days) only after ruling out other causes and only when quality of life is significantly impaired 2. This does not apply to musculoskeletal chest wall pain.

Appropriate Management of Intercostal Muscle Strain

• First-line treatment includes NSAIDs (such as ibuprofen 400-600 mg three times daily or naproxen 500 mg twice daily) for pain and inflammation, which are appropriate for musculoskeletal injuries.

• Rest, ice application in the first 48 hours, followed by heat therapy, and avoiding activities that exacerbate pain are standard supportive measures.

• Gentle stretching and breathing exercises once acute pain subsides help prevent stiffness and promote healing.

Address the Underlying Cough

• If the patient has persistent cough causing ongoing muscle strain, the cough itself needs treatment based on its etiology 1.

• For post-infectious cough, inhaled ipratropium bromide 2-3 puffs four times daily is first-line treatment 2, not oral corticosteroids.

• Oral prednisone (30-40 mg daily for 5-10 days) would only be considered if the cough represents severe post-infectious paroxysms significantly impairing quality of life after other treatments have failed, or if cough variant asthma is suspected 2, 3, 4.

Critical Pitfall to Avoid

• Do not prescribe corticosteroids for musculoskeletal pain conditions like intercostal muscle strain, as they provide no benefit and expose patients to unnecessary adverse effects including hyperglycemia, hypertension, and adrenal suppression 5, 6.