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Steroids not effective for chest infections in non-asthmatic adults

ChestInfectionOral steroids should not be used for treating acute lower respiratory tract infection (or 'chest infections') in adults who don't have asthma or other chronic lung disease, as they do not reduce the duration or severity of symptoms, according to a UK study.

In the study, carried out by researchers at the Universities of Bristol, Nottingham, Oxford and Southampton, 398 non-asthmatic adults with acute chest infections but no evidence of pneumonia and not requiring immediate antibiotic treatment were randomly split into two groups, one receiving 40mg of the oral steroid 'prednisolone' for five days (198 participants) and one receiving an identical placebo over the same time period (200 participants).

The team found there was no reduction in the duration of cough, the main symptom of chest infections, or the severity of the accompanying symptoms between two and four days after treatment (when symptoms are usually at their most severe) in the prednisolone group compared with the placebo group. The results suggest that steroids are not effective in the treatment of chest infections in non-asthmatic adult patients.

Alastair Hay, a GP and professor of primary care in the Bristol Medical School at the University of Bristol and lead author, said: "Chest infections are one of the most common problems in primary care and often treated inappropriately with antibiotics. Corticosteroids, like prednisolone, are increasingly being used to try to reduce the symptoms of chest infections, but without sufficient evidence. 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."

Professor Mike Moore, a study co-author from the University of Southampton, added: "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. 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. However, we have conclusively demonstrated they are not effective in this group of patients."

The research was funded by the National Institute for Health Research (NIHR) School for Primary Care Research.

Abstract
Importance: Acute lower respiratory tract infection is common and often treated inappropriately in primary care with antibiotics. Corticosteroids are increasingly used but without sufficient evidence.
Objective: To assess the effects of oral corticosteroids for acute lower respiratory tract infection in adults without asthma.
Design, Setting, and Participants: Multicenter, placebo-controlled, randomized trial (July 2013 to final follow-up October 2014) conducted in 54 family practices in England among 401 adults with acute cough and at least 1 lower respiratory tract symptom not requiring immediate antibiotic treatment and with no history of chronic pulmonary disease or use of asthma medication in the past 5 years.
Interventions: Two 20-mg prednisolone tablets (n = 199) or matched placebo (n = 202) once daily for 5 days.
Main Outcomes and Measures: The primary outcomes were duration of moderately bad or worse cough (0 to 28 days; minimal clinically important difference, 3.79 days) and mean severity of symptoms on days 2 to 4 (scored from 0 [not affected] to 6 [as bad as it could be]; minimal clinically important difference, 1.66 units). Secondary outcomes were duration and severity of acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, and adverse events.
Results: Among 401 randomized patients, 2 withdrew immediately after randomization, and 1 duplicate patient was identified. Among the 398 patients with baseline data (mean age, 47 [SD, 16.0] years; 63% women; 17% smokers; 77% phlegm; 70% shortness of breath; 47% wheezing; 46% chest pain; 42% abnormal peak flow), 334 (84%) provided cough duration and 369 (93%) symptom severity data. Median cough duration was 5 days (interquartile range [IQR], 3-8 days) in the prednisolone group and 5 days (IQR, 3-10 days) in the placebo group (adjusted hazard ratio, 1.11; 95% CI, 0.89-1.39; P = .36 at an α = .05). Mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, −0.20; 95% CI, −0.40 to 0.00; P = .05 at an α = .001). No significant treatment effects were observed for duration or severity of other acute lower respiratory tract infection symptoms, duration of abnormal peak flow, antibiotic use, or nonserious adverse events. There were no serious adverse events.
Conclusions and Relevance: 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.

Authors
Alastair D Hay; Paul Little; Anthony Harnden; Matthew Thompson; Kay Wang; Denise Kendrick; Elizabeth Orton; Sara T Brookes; Grace J Young; Margaret May; Sandra Hollinghurst; Fran E Carroll; Harriet Downing; David Timmins; Natasher Lafond; Magdy El-Gohary; Michael Moore

[link url="https://www.sciencedaily.com/releases/2017/08/170822111056.htm"]University of Bristol material[/link]
[link url="http://jamanetwork.com/journals/jama/article-abstract/2649201"]JAMA abstract[/link]

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