Can oral corticosteroids (e.g. prednisone) cause cough in patients, particularly those with a history of respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD)?

Oral Corticosteroids Do Not Cause Cough—They Treat It

Oral corticosteroids like prednisone are used to treat cough in specific respiratory conditions and do not cause cough as a side effect. The confusion may arise because inhaled corticosteroids can occasionally trigger cough due to aerosol dispersants, but this is not an issue with oral formulations 1.

When Oral Steroids Are Used to Treat Cough

Cough Variant Asthma

• For severe or refractory asthmatic cough, oral prednisone 40 mg daily for 1-2 weeks is recommended, followed by transition to inhaled corticosteroids 1.
• A diagnostic trial of prednisone 30 mg daily for 1-2 weeks can establish the diagnosis of cough variant asthma, with cough resolution expected within this timeframe 2, 3.
• Complete resolution of cough may require up to 8 weeks of inhaled corticosteroid therapy after the initial oral course 1.

Postinfectious Cough

• For severe paroxysms of postinfectious cough, prednisone 30-40 mg daily may be prescribed for a short, finite period after ruling out other causes 2.
• Inhaled ipratropium bromide should be tried first, with oral steroids reserved for refractory cases 2.

Interstitial Lung Diseases

• In sarcoidosis with cough, oral corticosteroids may lead to symptomatic improvement over 6-24 months, though an individualized risk-benefit analysis is necessary given significant side effects 1.
• For hypersensitivity pneumonitis with physiologic impairment, systemic corticosteroid therapy is recommended alongside removal of the offending exposure 1.

COPD Exacerbations

• Systemic corticosteroids (prednisone 40 mg daily for 5-7 days) are recommended for acute COPD exacerbations 4, 5.
• Long-term oral corticosteroids should not be used for maintenance therapy in stable chronic bronchitis 4.

Important Distinction: Inhaled vs. Oral Steroids

Inhaled Steroids Can Cause Cough

• Inhaled corticosteroids may induce or exacerbate cough due to aerosol dispersants, not the steroid molecule itself 1.
• Beclomethasone dipropionate causes cough more commonly than triamcinolone acetonide due to dispersant components 1.
• Before escalating therapy, consider inhaled steroid-induced cough, improper inhaler technique, or other contributing conditions like GERD 1.

Oral Steroids Do Not Cause Cough

• There is no evidence in the medical literature that oral corticosteroids cause cough as an adverse effect [1-6].
• Oral steroids are specifically used to suppress cough in various respiratory conditions 1, 2.

Side Effects of Oral Steroids (Not Including Cough)

Oral corticosteroids carry significant systemic side effects that require careful consideration 1, 4:

• Immunosuppression and increased infection risk 4
• Hyperglycemia 4
• Osteoporosis with prolonged use 4
• Hypothalamic-pituitary-adrenal axis suppression 6

Clinical Pitfall to Avoid

If a patient develops or worsens cough after starting "steroid therapy," determine whether they are using:

• Inhaled steroids: Consider switching formulations or checking inhaler technique 1
• Oral steroids: Look for another cause of cough, as oral steroids themselves do not cause this symptom 1, 2