From the Guidelines
Corticosteroids are not recommended for routine treatment of acute bronchitis in immunocompetent adult outpatients. Acute bronchitis is typically a self-limiting viral infection that resolves within 1-3 weeks, and corticosteroids do not significantly improve outcomes for most patients 1. Instead, treatment should focus on symptomatic relief with rest, adequate hydration, and over-the-counter medications like acetaminophen or NSAIDs for fever and discomfort.
Key Considerations
- The use of corticosteroids, including inhaled and oral forms, is not suggested for routine prescription in acute bronchitis cases without complicating factors 1.
- Differential diagnoses, such as exacerbations of chronic airways diseases (COPD, asthma, bronchiectasis), should be considered, as these conditions may require therapeutic management with oral corticosteroids.
- Antibiotics are also not indicated unless there is strong suspicion of a bacterial infection or the patient has underlying chronic lung disease.
Treatment Approach
- For cough management, over-the-counter medications may provide relief, but the prescription of specific therapies like antitussives, inhaled beta agonists, or inhaled anticholinergics should be based on individual patient needs and underlying conditions.
- The decision to use corticosteroids should be made cautiously, considering the potential side effects and the lack of significant benefit in uncomplicated acute bronchitis cases 1.
- In special circumstances, such as patients with asthma or COPD exacerbations triggered by bronchitis, short-course corticosteroids may be appropriate, as these patients have underlying airway inflammation that benefits from steroid treatment.
From the Research
Acute Bronchitis and Corticosteroids
- There is no direct mention of corticosteroids in the provided studies as a treatment for acute bronchitis 2, 3, 4, 5, 6.
- The studies focus on the diagnosis, management, and treatment of acute bronchitis, emphasizing that it is usually caused by viruses and that antibiotics are not indicated in patients without chronic lung disease 2, 3, 4.
- Antibiotics have been shown to provide only minimal benefit in reducing the duration of cough or illness, and have adverse effects such as allergic reactions, nausea, and vomiting 2, 6.
- The use of symptomatic treatment, such as protussives, antitussives, or bronchodilators, is recommended for managing acute bronchitis symptoms 3, 4.
- There is no evidence to suggest that corticosteroids are a recommended treatment for acute bronchitis in the provided studies.
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 4.
- Patient expectations for antibiotics and therapies for symptom management often differ from evidence-based recommendations, highlighting the need for effective communication strategies to provide the safest therapies available while maintaining patient satisfaction 4.
- A systematic review found that analgesics, antibiotics, antihistamines, antitussives, beta(2) agonists, and expectorants/mucolytics have been studied as potential treatments for acute bronchitis, but the quality of evidence for these interventions varies 5.
Antibiotic Use in Acute Bronchitis
- Antibiotic treatment of acute bronchitis is controversial, with most clinicians prescribing antibiotics despite expert recommendations against this practice 6.
- A Cochrane review found that antibiotic treatment had a modest beneficial effect in patients with acute bronchitis, but the magnitude of this benefit was similar to the detriment from potential adverse effects 6.