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a woman coughing image cbAugust 31 2017

Doctors are being advised not to prescribe prednisolone or other oral corticosteroids for non-asthmatic adults who present with acute lower respiratory tract infections.

 A study has concluded that prednisolone, given as 40mg once daily for five days, did not reduce symptom duration or severity. Researchers studied outcomes in 398 non-asthmatic adults and found median cough duration was five days in both the prednisolone and placebo groups. Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group.

In addition, “no significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, or non-serious adverse events.”

The UK study was funded by NIHR School for Primary Care Research and published in JAMA.

Alastair Hay, a GP and Professor of Primary Care in the Bristol Medical School at the University of Bristol and lead author, said: “Chest infections are one of the most common problems in primary care and often treated inappropriately with antibiotics. Corticosteroids, like prednisolone, are increasingly being used to try to reduce the symptoms of chest infections, but without sufficient evidence.

“Our study does not support the continued use of steroids as they do not have a clinically useful effect on symptom duration or severity. We would not recommend their use for this group of patients.”

Professor Mike Moore, a study co-author from the University of Southampton, added: “Oral and inhaled steroids are known to be highly effective in treating acute asthma as well as infective flares of other long-term lung conditions but need to be used carefully because of the risk of unwanted side effects.

“We chose to test the effect of steroids for chest infections as some of the symptoms of chest infections, such as shortness of breath, wheeze and cough with phlegm, overlap with acute asthma. However, we have conclusively demonstrated they are not effective in this group of patients.”

Links:
NIHR announcement  
NIHR SPCR announcement            
AD Hay et al. ‘Effect of Oral Prednisolone on Symptom Duration and Severity in Non-asthmatic Adults With Acute Lower Respiratory Tract Infection’. JAMA. 2017;318(8):721-730.  

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