What is the dose of prednisolone (corticosteroid) for asthma in adults?

From the Guidelines

For adults with asthma, the recommended dose of prednisolone during an acute exacerbation is 60 mg/day for 3-10 days, as stated in the study by 1. This dose is intended to reduce inflammation in the airways, decrease mucus production, and relax airway muscles. Some key points to consider when taking prednisolone for asthma include:

• Taking the medication in the morning with food to minimize stomach irritation and sleep disruption
• Continuing to use regular inhalers as directed
• Contacting a healthcare provider if symptoms worsen or do not improve after 2-3 days of treatment
• Being aware of potential side effects, such as increased appetite, mood changes, and sleep disturbances
• The importance of not stopping or tapering prednisolone if asthma symptoms are worsening, as noted in the study by 1 It's also important to note that the study by 1 suggests that a short course of oral systemic corticosteroids, such as prednisolone, may be considered to gain more rapid control for patients whose asthma frequently interrupts sleep or normal daily activities. However, the study by 1 recommends a dose of 30-40 mg daily, which is lower than the dose stated in the study by 1. Given the more recent and higher quality evidence from 1, the recommended dose of 60 mg/day for 3-10 days is preferred.

From the FDA Drug Label

The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses

• The provided information does not directly address the dose of prednisolone for adult asthma patients.
• The information provided is for children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators.
• There is no direct information in the label regarding the dose for adult asthma patients, only information for children and other conditions such as multiple sclerosis and nephrotic syndrome.
• The general dosage information provided is:
  • The initial dose of prednisolone sodium phosphate oral solution may vary from 1.67 mL to 20 mL (5 to 60 mg prednisolone base) per day depending on the specific disease entity being treated.
  • Dosage requirements are variable and must be individualized on the basis of the disease under treatment and the response of the patient 2

From the Research

Dose of Prednisolone for Asthma in Adults

• The dose of prednisolone for asthma in adults can vary depending on the severity of the exacerbation and the individual patient's response to treatment 3, 4, 5.
• A study published in 2011 found that oral prednisolone 100 mg once daily was effective in treating acute exacerbations of asthma in adults 3.
• Another study published in 1996 compared the efficacy of a short course of oral prednisolone (starting at 40 mg/day and reducing by 5 mg every other day) with a high dose of inhaled fluticasone propionate (2 mg daily) in the treatment of acute exacerbations of asthma in adults, and found that both treatments were equally effective 4.
• A prospective, placebo-controlled trial published in 2002 found that 5 days of oral prednisolone (40 mg daily) was as effective as 10 days of treatment in patients with acute asthma requiring hospital admission 5.
• The optimal duration of oral steroid treatment in the management of acute adult asthma is unclear, but it may be possible to reduce the standard steroid course to 5 days in acute adult asthma, provided all patients receive inhaled steroids and a personal asthma management plan 5, 6.

Key Findings

• Oral prednisolone is effective in treating acute exacerbations of asthma in adults 3, 4, 5.
• The dose of prednisolone can vary depending on the severity of the exacerbation and the individual patient's response to treatment 3, 4, 5.
• Inhaled corticosteroids can be used in conjunction with oral prednisolone to treat acute exacerbations of asthma in adults 4, 7.

Treatment Considerations

• The choice of treatment for acute exacerbations of asthma in adults should be based on the severity of the exacerbation and the individual patient's response to treatment 3, 4, 5, 6.
• Patients with severe asthma may require higher doses of prednisolone or longer courses of treatment 6, 7.
• Inhaled corticosteroids can be used to reduce the need for oral prednisolone and to prevent future exacerbations 4, 7.