From the FDA Drug Label
INDICATIONS AND USAGE Prednisolone sodium phosphate oral solution is indicated in the following conditions: ... Allergic States: ... asthma; ... Respiratory Diseases: ... asthma (as distinct from allergic asthma listed above under "Allergic States") The best oral steroid for asthma exacerbations is prednisolone 1.
- Key points:
- Prednisolone is indicated for asthma and asthma exacerbations.
- It is used to control severe or incapacitating allergic conditions, including asthma. Note that the label does not compare the efficacy of different oral steroids for asthma exacerbations, it only indicates that prednisolone can be used for this condition.
From the Research
Prednisone is the best oral steroid for asthma exacerbations, typically prescribed at 40-60mg once daily for 5-7 days for adults, as recommended by recent guidelines and studies 2. For children, the recommended dose is 1-2mg/kg/day (maximum 60mg) for the same duration. No tapering is needed for short courses under 10 days. The medication should be taken in the morning with food to minimize side effects like insomnia and stomach irritation. Prednisone works by reducing inflammation in the airways, decreasing mucus production, and relaxing airway smooth muscles, which helps improve breathing. While taking prednisone, patients should continue using their rescue inhaler as needed and maintain their controller medications. Common side effects include increased appetite, mood changes, elevated blood sugar, and fluid retention, but these are typically temporary with short courses. Patients with diabetes should monitor their blood sugar more frequently while taking prednisone. Alternative oral steroids include methylprednisolone and dexamethasone, but prednisone remains the most commonly used due to its well-established efficacy, predictable absorption, and reasonable cost.
Some key points to consider when prescribing oral steroids for asthma exacerbations include:
- The dose and duration of treatment should be individualized based on the severity of the exacerbation and the patient's response to treatment 3.
- Oral steroids should be used in conjunction with other treatments, such as bronchodilators and inhaled corticosteroids, to achieve optimal control of symptoms 4.
- Patients should be monitored closely for signs of adverse effects, such as increased blood sugar and fluid retention, and for evidence of treatment response, such as improved lung function and symptom reduction 5.
- The use of oral steroids should be minimized to the shortest duration necessary to control symptoms, to reduce the risk of adverse effects and to prevent rebound exacerbations 2.
Overall, the use of oral steroids, such as prednisone, is a crucial component of the management of asthma exacerbations, and should be guided by recent evidence and clinical guidelines to optimize patient outcomes.