Prednisolone has little benefit in acute lower respiratory tract infections in nonasthmatic patients
A short course of moderate-dose oral prednisolone appears to have little impact on symptom severity or duration in nonasthmatic adults with acute lower respiratory tract infection, according to the OSAC* trial.
In this multicentre (54 primary care clinics in England), randomized trial, patients (n=401, mean age 47.4 years, 63 percent female) presenting with acute cough (≤28 days) and ≥1 lower respiratory tract symptom (chest pain, wheezing, phlegm, or shortness of breath) not requiring immediate antibiotic treatment received once-daily doses of two 20 mg prednisolone tablets (n=199) or placebo (n=202) for 5 days. Patients with a history of chronic pulmonary disease or asthma medication use in the previous 5 years were excluded.
Symptoms (ie, cough, shortness of breath, phlegm, sleep disturbance, general feeling of unwell, and activity disturbance) were categorized according to severity on a scale from 0 (no problem) to 6 (“as bad as it could be”) and were measured daily for up to 28 days or until resolution, while cough was measured for an additional 28 days.
Duration of moderately bad or worse cough was similar in patients who received prednisolone and placebo (mean duration, 5 days for both; adjusted hazard ratio, 1.11, 95 percent confidence interval [CI], 0.89–1.39; p=0.36). [Lancet 2017;318:721-730]
Symptom severity score between days 2 and 4 was also comparable between patients on prednisolone and placebo (1.99 vs 2.16; adjusted mean difference, 0.20 points, 95 percent CI, -0.40 to 0.00; p=0.05).
There was no difference between patients on prednisolone and placebo in terms of duration or severity of any of the symptoms or antibiotic use up to 28 days, duration of cough up to 56 days, or duration of abnormal peak flow, and there were no serious adverse events reported in either group.
“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,” said the researchers, who called for further research to assess the use of corticosteroids in patients who present at primary care clinics with more severe infections.
“[This] trial also contributes to a growing body of evidence suggesting that systemic and topical corticosteroids have a limited role in the treatment of common infections and their postinfectious complications in primary care,” they said.
The researchers did not discount the possibility that patients with chronic or postinfectious cough may have inadvertently been included or that the use of patient-reported outcomes may have influenced the findings.
*OSAC: Oral Steroids for Acute Cough