Short-term oral corticosteroids no better than placebo at treating lower respiratory tract infection symptoms, study finds
Researchers randomized 199 patients to receive two 20-mg prednisolone tablets and 202 patients to receive placebo once daily for five days, with primary outcomes of duration of moderately bad or worse cough and mean symptom severity on days two and four.
Five days of oral corticosteroids did not reduce symptoms of acute lower respiratory tract infection in adults without asthma in a recent randomized placebo-controlled trial.
At 54 family practices in England, researchers enrolled 401 adults with acute cough and at least one lower respiratory tract symptom not requiring immediate antibiotic treatment. Patients had no history of chronic pulmonary disease or use of asthma medication in the past five years.
Researchers randomized 199 patients to receive two 20-mg prednisolone tablets and 202 patients to receive placebo once daily for five days. The primary outcomes were the duration of moderately bad or worse cough (0 to 28 days; minimal clinically importance difference, 3.79 days) and mean symptom severity on days two and four (scale of 0 [not affected] to 6 [worst]; minimal clinically important difference, 1.66 units).
Results were published online on Aug. 22 by JAMA.
Two patients withdrew from the study, and one patient duplicate was identified, leaving 398 patients with baseline data (mean age, 47 years). Their symptoms included phlegm (77%), shortness of breath (70%), wheezing (47%), chest pain (46%), and abnormal peak flow (42%).
Of these, 334 patients (84%) provided cough duration data, and 369 (93%) provided symptom severity data. After the intervention, neither cough duration nor symptom severity was significantly different between groups.
In the prednisolone group, median cough duration was five days (interquartile range, 3 to 8 days), compared to five days (interquartile range, 3 to 10 days) in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89 to 1.39). Mean symptom severity was 1.99 points in the prednisolone group, compared to 2.16 points in the placebo group (adjusted difference, −0.20 point; 95% CI, −0.40 to 0.00 points).
The authors noted limitations to the study, such as certain unmeasured biomarkers, the use of a patient-reported outcome rather than an objective outcome measure, and a higher than expected number of participants with zero duration of moderately bad or worse cough.
“This trial suggests that oral corticosteroids should not be used in adult primary care patients without asthma or chronic obstructive pulmonary disease who do not require treatment with an immediate antibiotic,” they wrote.