What is the recommended dosing of prednisone (corticosteroid) for acute bronchitis in patients with cancer?

From the Guidelines

Prednisone dosing for bronchitis in cancer patients should be initiated at 40 mg once daily for 5 days, with a maximum dose of 60 mg/day, to minimize side effects and optimize outcomes. Cancer patients often require careful consideration due to their potentially compromised immune systems and interactions with cancer treatments. The medication works by reducing inflammation in the airways, decreasing mucus production, and suppressing the excessive immune response causing bronchial irritation. According to the most recent and highest quality study available, specifically the 2012 KDIGO practice guideline on glomerulonephritis 1, oral prednisone should be administered as a single daily dose starting at 60 or 2 mg/kg/day to a maximum dose of 60 mg/day. However, in the context of bronchitis in cancer patients, a more conservative approach is often preferred to balance efficacy with the risk of side effects.

Key considerations in determining the prednisone dose include:

• Severity of bronchitis symptoms
• Patient's overall condition and cancer type
• Current cancer treatments and potential interactions
• Risk of infection and immune system compromise
• Need for blood glucose monitoring, especially in patients with diabetes or those on concurrent steroids for cancer management

It is essential to weigh the benefits of prednisone treatment against the potential risks, such as hyperglycemia, mood changes, and increased infection risk, which are particularly concerning in cancer patients. Patients should take the medication with food to reduce stomach irritation and follow the prescribed schedule exactly without abrupt discontinuation. While another study suggests a daily single dose of 1 mg/kg (maximum 80 mg) or alternate-day single dose of 2 mg/kg (maximum 120 mg) 1, the more conservative approach aligned with the 2012 KDIGO guideline 1 is preferred for cancer patients with bronchitis to prioritize morbidity, mortality, and quality of life outcomes.

From the FDA Drug Label

The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT

The FDA drug label does not provide specific dosing recommendations for prednisone in patients with bronchitis and cancer.

• Dosing requirements are variable and must be individualized based on the disease under treatment and the patient's response.
• The initial dosage may range from 5 mg to 60 mg per day, but the label does not provide guidance on dosing for bronchitis in cancer patients 2.

From the Research

Prednisone Dosing for Bronchitis in Cancer Patients

• The use of prednisone for bronchitis in cancer patients is not well-established, but it has been used in certain cases to manage immune-related adverse events (IRAEs) associated with immune checkpoint inhibitors (ICIs) 3.
• In a case report, high-dose prednisone was administered to two patients with lung cancer who developed severe airway disease attributable to ICIs, resulting in variable outcomes 3.
• There is no standard dosing regimen for prednisone in the management of bronchitis in cancer patients, and its use should be individualized based on the patient's specific condition and response to treatment.
• The evidence for the use of corticosteroids, including prednisone, in cancer-related pain management is limited, and further trials are needed to establish their safety and effectiveness 4.

Management of Acute Bronchitis

• Acute bronchitis is a self-limiting disease, and evidence does not support the use of antitussives, honey, antihistamines, anticholinergics, oral nonsteroidal anti-inflammatory drugs, or inhaled or oral corticosteroids 5.
• Symptom relief and patient education regarding the expected duration of cough (2-3 weeks) are recommended for the management of acute bronchitis 5.
• Bronchodilators may be used to manage symptoms of bronchitis, especially in patients with underlying airway disease such as chronic obstructive pulmonary disease (COPD) or asthma 6, 7.

Considerations for Cancer Patients with Bronchitis

• Cancer patients with bronchitis may require individualized management due to their underlying condition and potential immune suppression.
• The use of prednisone or other corticosteroids in cancer patients with bronchitis should be carefully considered, taking into account the potential benefits and risks, including the risk of immune suppression and adverse events 3, 4.