Researchers determine whether oral corticosteroids, such as prednisolone, reduce symptom duration or severity for acute lower respiratory tract infection in non-asthmatic adults.
Acute lower respiratory tract infection (LRTI), defined as an acute cough with at least one of the symptoms of sputum, chest pain, shortness of breath, and wheezing is one of the most common conditions managed in primary care internationally. It is often treated inappropriately with antibiotics. Although corticosteroid use is increasing, there is no sufficient evidence proving its effectiveness. Researchers sought to determine whether oral corticosteroids, such as prednisolone, reduce symptom duration or severity for acute LRTI in non-asthmatic adults. They published their results in JAMA.
A randomized, placebo-controlled trial took place at 54 family practices in England between July 2013 and October 2014. It included 398 non-asthmatic adults with acute LRTI who were split into two groups, one receiving 40mg of oral prednisolone for five days (198 participants) and one receiving an identical placebo over the same time (200 participants). The dose and duration of prednisolone were selected to reflect the dose and duration known to be effective for acute asthma.
The primary outcomes were duration of moderately bad or worse cough and mean severity of symptoms scored from 0 (not affected) to 6 (as bad as it could be). Secondary outcomes were duration and severity of acute LRTI symptoms, duration of abnormal peak flow, antibiotic use, and adverse events.
Median cough duration was five days in the prednisolone group and five days in the placebo group. Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group.
Researchers did not observe any significant treatment effects for duration or severity of other acute LRTI symptoms, duration of abnormal peak flow, antibiotic use, or non-serious adverse events. Furthermore, there were no serious adverse events reported.
The results of this study suggest that oral prednisolone should not be used for acute lower respiratory tract infection in non-asthmatic adults. This study is the first of its kind to examine the use of oral, rather than inhaled corticosteroids. Further research will be required to determine whether it is effective in other patient groups.
Written by Christine Gison
Hay AD, Little P, Harnden 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: 721-730. doi: 10.1001/jama.2017.10572