Clinical Question

Are steroids useful in the treatment of acute lower respiratory tract infection (LRTI) in adults without asthma?

Bottom Line

This study found no clinically significant benefit of steroids for the treatment of acute LRTI in adults without asthma, including those presenting with wheezing or shortness of breath. (Level of Evidence = 1b)

Synopsis

Because symptoms of acute LRTI can mimic exacerbated asthma, steroids are commonly prescribed with or without antibiotics. These investigators enrolled adults, 18 years or older, presenting with an acute cough (lasting 28 days or less) as the main symptom and at least one other lower respiratory tract symptom (e.g., phlegm, chest pain, wheezing, shortness of breath). Exclusion criteria included evidence of chronic pulmonary disease, having received any asthma medication in the previous five years, or requiring same-day hospitalization or urgent antibiotic treatment. Patients (N = 401) randomly received (concealed allocation assignment) 40 mg of prednisolone daily for five days or matched placebo. Those patients also receiving a nonurgent antibiotic prescription were asked to delay filling the prescription for at least 48 hours. Patients assessed outcomes using symptom diaries and remained masked to their treatment group assignment. Symptoms were measured daily, including twice-daily peak expiratory flow, for 28 days or until symptom resolution. Complete follow-up occurred for 94% of patients at 28 days.

Using intention-treat analysis, no clinically significant group differences occurred in the median duration of cough or severity of symptoms, symptom duration, antibiotic use, peak flow, or patient satisfaction. There were also no significant subgroup effect differences (i.e., smoking, wheezing, chest pain, shortness of breath).

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (primary care)

Reference: HayADLittlePHarndenAet alEffect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. JAMA2017;318(8):721–730.