Cough Management with Prednisolone

Introduction to Prednisolone Use

The American Thoracic Society recommends that prednisolone should not be used as a first-line treatment for most types of cough, but may be considered in specific conditions such as cough variant asthma, eosinophilic bronchitis, or severe post-infectious cough that has not responded to other treatments 1, 2, 3

For post-infectious cough, first-line treatment should be inhaled ipratropium bromide, which has demonstrated efficacy in controlled trials 3
For severe paroxysms of post-infectious cough that adversely affect quality of life and persist despite other treatments, consider prednisolone 30-40 mg daily for a short, finite period 3
Prednisolone 30 mg/day for 2 weeks may be used as a diagnostic-therapeutic trial for suspected cough variant asthma or eosinophilic bronchitis 1, 2
After diagnosis of cough variant asthma, patients should be transitioned to inhaled corticosteroids for long-term management 1, 2

For ILD-associated cough, the approach depends on the specific type of ILD, and in idiopathic pulmonary fibrosis (IPF), systemic corticosteroids are not recommended due to increased mortality when used in combination therapy 5
In sarcoidosis, oral corticosteroids may improve symptoms including cough, but require an individualized analysis of benefit and risk 6

For suspected cough variant asthma or eosinophilic bronchitis, prescribe prednisolone 30 mg daily for 2 weeks, and assess response within 3 days 1, 2
For severe post-infectious cough, consider prednisolone 30-40 mg daily for a short, finite period, after failure of inhaled ipratropium bromide and inhaled corticosteroids 3

Long-term systemic corticosteroid use carries significant side effects that must be weighed against potential benefits 5, 6
Always rule out other common causes of chronic cough before considering prednisolone 1, 2, 3
For bronchiectasis, inhaled corticosteroids may be more appropriate than systemic corticosteroids for long-term management 7
Assess improvement in cough frequency, severity, and impact on quality of life, and if no response within 2 weeks, reconsider diagnosis and treatment approach 1, 2, 4, 8