Lower Respiratory Tract Infection: Symptom Duration and Severity With Oral Prednisolone

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The median length of cough duration was the same in both the prednisolone group and the placebo group.
The median length of cough duration was the same in both the prednisolone group and the placebo group.

Antibiotics are frequently and inappropriately used for the treatment of acute lower respiratory tract infection (LRTI) in adults without asthma. Researchers of the present multicenter placebo-controlled randomized trial published in the Journal of the American Medical Association, sought to assess the effects of oral corticosteroid use for acute LRTIs in adults without asthma.

The Oral Steroids for Acute Cough (OSAC) trial was conducted between July 2013 and October 2014 in 54 family practices throughout England. A total of 398 adults with symptoms of acute LRTI — acute cough along with ≥1 of the following symptoms: sputum production, chest pain, shortness of breath, and wheeze — were enrolled in the study. Participants received either 2 20 mg-prednisolone tablets (n=198) or matched placebo (n=200) once daily for 5 days.

 

Primary study outcomes included duration of moderately bad or worse cough (0-28 days) and mean severity score (range, 0-6) of the 6 main symptoms (cough, phlegm, shortness of breath, sleep disturbance, feeling generally unwell, and activity disturbance) on days 2 to 4 (scored from 0 [not affected] to 6 [maximum]). Secondary outcomes included duration and severity of LRTI symptoms, duration of abnormal peak flow, antibiotic use, and adverse events.

Mean patient age was 47 years; 63% of the participants were women and 17% were smokers. Overall, 77% of patients reported phlegm, 70% shortness of breath, 47% wheezing, and 46% chest pain. Abnormal peak flow was observed in 42% of participants.

Median cough duration was 5 days in the prednisolone group and 5 days in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89-1.39; P =.36). Mean symptom severity was 1.99 points in the prednisolone group vs 2.16 in the placebo group (adjusted difference, -0.20; 95% CI, 0.40-0.00; P =.05). No significant treatment effects were reported for duration or severity of other acute LRTI symptoms, duration of abnormal peak flow, antibiotic use, or adverse events.

The investigators concluded that the use of oral corticosteroids for 5 days in adults with acute LRTI without asthma did not reduce symptom severity or duration. 

Reference

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.

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