Skip to main content

Research Repository

See what's under the surface

Advanced Search

Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial

Hay, Alastair D.; Little, Paul; Harnden, Anthony; Thompson, Matthew; Wang, Kay; Kendrick, Denise; Orton, Elizabeth; Brookes, Sara T.; Young, Grace J.; May, Margaret; Hollinghurst, Sandra; Carroll, Fran E.; Downing, Harriet; Timmins, David

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



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.

Journal Article Type Article
Publication Date Aug 22, 2017
Journal Journal of the American Medical Association
Print ISSN 0098-7484
Electronic ISSN 1538-3598
Publisher American Medical Association
Peer Reviewed Peer Reviewed
Volume 318
Issue 8
APA6 Citation Hay, A. D., Little, P., Harnden, A., Thompson, M., Wang, K., Kendrick, D., …Timmins, D. (2017). Effect of oral prednisolone on symptom duration and severity in nonasthmatic adults with acute lower respiratory tract infection: a randomized clinical trial. Journal of the American Medical Association, 318(8), doi:10.1001/jama.2017.10572
DOI https://doi.org/10.1001/jama.2017.10572
Keywords Oral Prednisolone; Symptom duration; Nonasthmatic adults; Acute Lower Respiratory Tract Infection; Randomised Controlled Trial.
Publisher URL http://jamanetwork.com/journals/jama/fullarticle/2649201
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
;