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Oral prednisolone for acute lower respiratory tract infection in clinically unrecognised asthma: an exploratory analysis of the Oral Steroids for Acute Cough (OSAC) randomised trial

Oral prednisolone for acute lower respiratory tract infection in clinically unrecognised asthma: an exploratory analysis of the Oral Steroids for Acute Cough (OSAC) randomised trial
Oral prednisolone for acute lower respiratory tract infection in clinically unrecognised asthma: an exploratory analysis of the Oral Steroids for Acute Cough (OSAC) randomised trial
Background Acute lower respiratory tract infection (ALRTI) is often treated in primary care with antibiotics. The recent ‘OSAC’ RCT showed corticosteroids were not an effective alternative in non-asthmatic adults with ALRTI.Aim To investigate if corticosteroids are beneficial for ALRTI in patients with unrecognised asthma. Design and Setting Exploratory analysis of the primary care OSAC trial Methods Sub-group analysis in patients responding yes to the International Primary Care Airways Group (IPCAG) question: did you have wheeze and/or at least two of nocturnal cough/chest tightness/dyspnoea in the past year. Sensitivity analysis in those answering yes to wheeze and at least two of the nocturnal symptoms. Primary outcomes: duration of cough (0 to 28 days, minimum clinically important difference (MCID) of 3.79 days) and mean symptoms’ severity score (0 to 6; MCID 1.66 units).Results Forty (10%) patients were included in the main analysis: mean age 49 (SD, 17.9) years, 52% male. Median cough duration was 3 days in both prednisolone (interquartile range [IQR], 2-6 days) and placebo (IQR, 1-6 days) groups (adjusted hazard ratio (HR), 1.10; 95% CI, 0.47-2.54; P=0.83), equating to 0.24 days longer (95% CI 1.23 days shorter to 2.88 days longer). Mean symptom severity difference was -0.14 (95% CI -0.78, 0.49, P=0.65) comparing prednisolone with placebo. Similar findings were found in the sensitivity analysis.Conclusion We found no evidence to support the use of corticosteroids for ALRTI in patients with clinically unrecognised asthma. Clinicians should not the IPCAG questions to target oral corticosteroid treatment in patients with ALRTI.
Hawkey, Sean
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Young, Grace J.
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
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Hay, Alistair D.
4ac520e7-944a-4732-b074-5436b4570f76
Hawkey, Sean
69befb94-e551-4bfb-b46c-c98c9a8b7de8
Young, Grace J.
34e6c6a3-80ca-4a55-b0c8-1b3f51093f21
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Hay, Alistair D.
4ac520e7-944a-4732-b074-5436b4570f76

Hawkey, Sean, Young, Grace J., Little, Paul, Moore, Michael and Hay, Alistair D. (2020) Oral prednisolone for acute lower respiratory tract infection in clinically unrecognised asthma: an exploratory analysis of the Oral Steroids for Acute Cough (OSAC) randomised trial. BJGP Open, 4 (5). (doi:10.3399/bjgpopen20X101099).

Record type: Article

Abstract

Background Acute lower respiratory tract infection (ALRTI) is often treated in primary care with antibiotics. The recent ‘OSAC’ RCT showed corticosteroids were not an effective alternative in non-asthmatic adults with ALRTI.Aim To investigate if corticosteroids are beneficial for ALRTI in patients with unrecognised asthma. Design and Setting Exploratory analysis of the primary care OSAC trial Methods Sub-group analysis in patients responding yes to the International Primary Care Airways Group (IPCAG) question: did you have wheeze and/or at least two of nocturnal cough/chest tightness/dyspnoea in the past year. Sensitivity analysis in those answering yes to wheeze and at least two of the nocturnal symptoms. Primary outcomes: duration of cough (0 to 28 days, minimum clinically important difference (MCID) of 3.79 days) and mean symptoms’ severity score (0 to 6; MCID 1.66 units).Results Forty (10%) patients were included in the main analysis: mean age 49 (SD, 17.9) years, 52% male. Median cough duration was 3 days in both prednisolone (interquartile range [IQR], 2-6 days) and placebo (IQR, 1-6 days) groups (adjusted hazard ratio (HR), 1.10; 95% CI, 0.47-2.54; P=0.83), equating to 0.24 days longer (95% CI 1.23 days shorter to 2.88 days longer). Mean symptom severity difference was -0.14 (95% CI -0.78, 0.49, P=0.65) comparing prednisolone with placebo. Similar findings were found in the sensitivity analysis.Conclusion We found no evidence to support the use of corticosteroids for ALRTI in patients with clinically unrecognised asthma. Clinicians should not the IPCAG questions to target oral corticosteroid treatment in patients with ALRTI.

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Accepted/In Press date: 7 May 2020
e-pub ahead of print date: 15 December 2020
Published date: December 2020

Identifiers

Local EPrints ID: 441048
URI: http://eprints.soton.ac.uk/id/eprint/441048
PURE UUID: 3735e288-350d-4cde-8e84-18b9a0a6b386
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 28 May 2020 16:58
Last modified: 09 Jan 2022 03:18

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Contributors

Author: Sean Hawkey
Author: Grace J. Young
Author: Paul Little
Author: Michael Moore ORCID iD
Author: Alistair D. Hay

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