From the Guidelines
For an eight-year-old with asthma exacerbation, I recommend giving prednisone at a dose of 1-2 mg/kg/day (typically 20-30 mg) for 3-5 days, as this oral corticosteroid helps reduce airway inflammation quickly, according to the guidelines provided by 1. This dose is consistent with the most recent and highest quality study, which suggests that there is no known advantage for higher doses of corticosteroids in severe asthma exacerbations 1.
Key Treatment Components
- Provide albuterol via metered-dose inhaler with spacer (2 puffs every 4-6 hours as needed) or nebulizer (2.5 mg every 4-6 hours as needed) to relieve bronchospasm.
- If the exacerbation is moderate to severe, consider adding ipratropium bromide (Atrovent) to the albuterol treatments for the first 24-48 hours.
- Ensure the child is using proper inhaler technique and has a spacer device.
- Monitor oxygen saturation and respiratory status closely, and if the child shows signs of severe distress (difficulty speaking, retractions, cyanosis), seek emergency care immediately.
Additional Considerations
- The total course of systemic corticosteroids for an asthma exacerbation requiring an ED visit or hospitalization may last from 3 to 10 days, with no need to taper the dose for courses of less than 1 week 1.
- Inhaled corticosteroids (ICSs) can be started at any point in the treatment of an asthma exacerbation, and there is probably no need to taper the dose for slightly longer courses (e.g., up to 10 days), especially if patients are concurrently taking ICSs 1.
- Heliox-driven albuterol nebulization can also be considered in these patients, as it can quickly decrease the work of breathing 1.
From the Research
Treatment for Asthma Exacerbation
- For an 8-year-old with asthma exacerbation, the treatment should include a short-acting β2 agonist and systemic corticosteroids to reduce airway inflammation 2.
- The oral route is favored for systemic corticosteroids unless there is a contraindication 2.
Dosage of Prednisone
- The recommended dose of prednisone for children is 1 to 2 mg/kg daily for 5 days 3.
- A study comparing 1 mg/kg/day and 2 mg/kg/day of oral prednisolone for 3 days in preschool children with acute moderate asthma exacerbations found that 1 mg/kg/day was not inferior to 2 mg/kg/day in terms of clinical improvement and recurrence of wheeze within 1 week, and had less frequent vomiting 4.
Additional Treatment
- Short-acting muscarinic antagonists can be effective as bronchodilators for asthma in the acute setting 2.
- Magnesium sulfate infusion has been associated with fewer hospitalizations in patients with severe exacerbations 5.
- Helium-oxygen mixtures can be used in patients who do not respond to standard therapies or those with severe disease 2.
- Inhaled corticosteroids and consideration of stepping up asthma maintenance therapy are important next steps to prevent future exacerbations 5.