1. The Research Question
In non-asthmatic adults presenting to primary care with acute lower respiratory tract infection and not requiring immediate antibiotics - does a moderately high dose oral corticosteroid (40mg prednisolone) reduce: (i) duration of moderately bad or worse cough; and/or (ii) early phase (days 2 to 4) symptom severity?

2. What the Researchers Did
We randomised 401 non-asthmatic adults with acute (≤28 days) lower respiratory tract infection, presenting to 54 GP practices in England.
Patients received 2x20mg prednisolone tablets or matched placebo for 5 days.
The two primary outcomes were: duration of moderately bad or worse (MBW) cough (348 needed for a priori beta 0.9, two-sided alpha 0.05); and average severity of all symptoms days 2 to 4 (beta 0.89, adjusted alpha 0.001).

3. What the Researchers Found
Primary outcomes were available in 333 for duration of moderately bad or worse cough and 367 for symptom severity
Median duration of moderately bad or worse cough was 5 days in both groups (IQRs 2-8 and 3-8 for prednisolone and placebo), adjusted HR 1.11 (95% CI 0.89 to 1.39, p= 0.357). Mean symptom severities were 1.99 and 2.16, adjusted difference (95% CI to 0.00, p= 0.054)

4. What This Means for Clinical Practice
For adults with acute lower respiratory tract infection not requiring immediate antibiotic treatment, a moderately high dose of oral corticosteroid does not reduce the duration of moderately bad or worse cough, or symptom severity in the early phase of the illness (when symptoms are usually worst). Clinicians should not prescribe oral steroids to this group.