Oral Corticosteroids Are Ineffective For Patients Without Asthma

Oral corticosteroids do not reduce acute lower respiratory tract infection symptom severity or duration among adults without asthma, according to a recent study.

The multicenter, placebo-controlled, randomized trial was conducted in 54 family practices in England and included a total of 401 adults who presented with an acute cough and at least 1 lower respiratory tract symptom that did not require immediate antibiotic treatment. None of the patients had a history of chronic pulmonary disease or asthma mediation use in the past 5 years. For 5 days, 199 patients took 2 prednisolone (20 mg) tablets and 202 patients were given matching placebo.
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The duration of moderately bad or worse cough and mean symptom severity on days 2 through 4, which was scored from 0 (unaffected) to 6 (as bad as it could be), were assessed as the primary outcomes. Secondary outcomes included duration and severity of acute lower respiratory tract infections symptoms, duration of abnormal peak flow, antibiotic use, and adverse events.

Among the 398 patients with baseline data who completed the study, 334 provided cough duration and 369 provided symptom severity data.

Overall, the median cough duration was 5 days in both the prednisolone group and placebo group. The mean symptom severity scores did not differ significantly between groups, with 1.99 points and 2.16 points for the prednisolone group and placebo group, respectively.

In addition, there were no differences between the groups for the duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, and non-serious adverse events. No serious adverse events were reported.

“Oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma because they do not reduce symptom duration or severity,” the researchers concluded.

—Melissa Weiss

Reference:

Hay AD, Little P, Harden A, et al. Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. JAMA. 2017;318(8):721-730. doi:10.1001/jama.2017.10572.