Should oral corticosteroids be used to treat adults without asthma or other lung disease presenting to primary care with acute lower respiratory tract infection (ALRTI)? That is the question asked by a team of researchers led by the Bristol Randomised Trials Collaboration at the University of Bristol.
The team studied 398 adults with ALRTI but no asthma or other chronic lung disease who attended one of 54 included GP practices in England. Patients were followed up for 28 days. Half of the cohort (n=198) received two 20 mg oral prednisolone per day for five days and half (n=200) received placebo.
The authors report that NHS costs were dominated by primary care contacts, which were higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05-£8.52).
The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean ‘profit’ to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient, they say.
There was a quality-adjusted life-years gain of 0.03 (95% CI 0.01-0.05) equating to half a day of perfect health favouring prednisolone. There was no difference in duration of cough or severity of symptoms.
Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms, the authors conclude.
