Steroids Ineffective for Chest Infections in Patients Without Lung Diseases

Oral steroids may not be the best treatment option for patients with lower respiratory tract infections who do not have asthma or other lung diseases, according to an article published by JAMA.

"Chest infections are one of the most common problems in primary care and often treated inappropriately with antibiotics,” said lead author Alastair Hay, MD. “Corticosteroids, like prednisolone, are increasingly being used to try to reduce the symptoms of chest infections, but without sufficient evidence.”

The authors found that steroids were not able to reduce symptoms among patients without other lung conditions, such as asthma.

Included in the study were 398 non-asthmatic patients with acute chest infections, excluding pneumonia, who did not require immediate antibiotic treatment. Patients were randomized to receive 40-mg of prednisolone or a placebo for 5 days.

"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,” said study co-author Mike Moore, BM, BS, MRCP, FRCGP. “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.”

The authors discovered that duration of cough or the severity of other symptoms were not reduced within 2 to 4 days of treatment among patients administered prednisolone compared with placebo, according to the study.

Since this time period is associated with the strongest symptoms, the authors believe that steroids may not be the most effective approach for treating non-asthmatic patients with chest infections.

“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,” Dr Hay said.

Many patients with chest infections are treated unnecessarily with antibiotics, according to the authors. Despite the lack of evidence, the use of steroids among this population has become increasingly popular.

These findings suggest that steroids may also not be an effective treatment for non-asthmatic patients with acute chest infections, according to the study.

“Among adults without asthma who developed acute lower respiratory tract infection, the use of oral prednisolone for 5 days did not reduce symptom duration or severity,” the authors concluded. “These findings do not support oral steroids for treatment of acute lower respiratory tract infection in the absence of asthma.”