Bristol, UK—Oral steroids often are prescribed for adult patients with an acute lower respiratory tract infection, but a new study suggests those drugs might be unnecessary.

The article
in JAMA notes that, among adults without asthma, a 5-day prednisolone prescription did not reduce symptom duration or severity.

As one of the conditions in which antibiotics often are inappropriately prescribed, according to background information in the report, acute cough with at least one of the symptoms of sputum, chest pain, shortness of breath, and wheeze increasingly is treated with corticosteroids.

The problem, note study authors led by University of Bristol, England, researchers, is that not enough evidence exists to opt for that therapy.

To determine effectiveness, the study team assigned 401 adults with acute cough to receive either two 20-mg prednisolone tablets or matched placebo once daily for 5 days.

Participants had at least one lower respiratory tract symptom not requiring immediate antibiotic treatment and also had no history of chronic pulmonary disease or use of asthma medication in the past 5 years. With 334 of them providing cough-duration data, 369 patients reported symptom-severity data.

Results indicate no difference in median cough durations—5 days in the prednisolone group and 5 days in the placebo group. Study authors report that no significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, antibiotic use, or nonserious adverse events. No serious adverse events were reported during the study.

The study had some limitations, according to the authors, including a higher-than- expected number of participants with zero duration of moderately bad or worse cough, although a sensitivity analysis including these participants did not influence the results.

“Oral corticosteroids should not be used for acute lower respiratory tract infection symptoms in adults without asthma because they do not reduce symptom duration or severity,” the researchers conclude.

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