From the Guidelines
For an asthma exacerbation, methylprednisolone (Solu-Medrol) is typically the preferred corticosteroid injection, usually administered at a dose of 125 mg intravenously, as it has been shown to hasten the resolution of airflow obstruction and may reduce hospital admissions 1.
Key Considerations
- The early use of systemic steroids is crucial in managing asthma exacerbations, as it may take 6 to 12 hours for the anti-inflammatory effects to become apparent 1.
- While there may be no difference in clinical effects between oral and IV formulations of corticosteroids, the IV route is preferable in patients with severe asthma 1.
- Alternatively, dexamethasone can be used at a dose of 10 mg IV or IM, but methylprednisolone is generally preferred due to its faster onset of action.
Additional Guidance
- For less severe cases, prednisone 40-60 mg orally may be sufficient, but this should be determined on a case-by-case basis, taking into account the patient's response to therapy and medical history.
- The injection should be followed by oral corticosteroids (usually prednisone 40-60 mg daily) for 5-7 days to prevent relapse, as recommended by the guidelines 1.
- Patients should continue using their rescue inhalers as needed and follow up with their healthcare provider to adjust their maintenance therapy.
- Patients with diabetes should be monitored for elevated blood glucose levels after receiving corticosteroids, as these medications can cause temporary hyperglycemia.
From the FDA Drug Label
Intramuscular Where oral therapy is not feasible, injectable corticosteroid therapy, including KENALOG-40 Injection and KENALOG-80 Injection (triamcinolone acetonide injectable suspension, USP) is indicated for intramuscular use as follows: Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma
- The triamcinolone injection is indicated for the control of severe or incapacitating allergic conditions, including asthma.
- The best corticosteroid shot for an asthma exacerbation is triamcinolone (IM) 2.
From the Research
Corticosteroid Options for Asthma Exacerbation
- The choice of corticosteroid for asthma exacerbation depends on various factors, including the severity of the exacerbation, patient age, and comorbidities 3, 4, 5.
- Commonly used corticosteroids for asthma exacerbation include prednisolone, dexamethasone, methylprednisolone, and betamethasone 3.
- A study comparing the efficacy and safety of two regimens of sequential systemic corticosteroids found that intravenous methylprednisolone followed by oral methylprednisolone was more efficacious and safer than intravenous hydrocortisone followed by oral prednisolone 6.
Administration Routes and Dosages
- Corticosteroids can be administered orally, intravenously, or intramuscularly 4, 6, 7.
- A pilot study found that a single intramuscular dose of methylprednisolone was a safe and effective alternative to oral steroid therapy for patients with asthma or chronic obstructive pulmonary disease (COPD) 7.
- The optimal dosage and duration of corticosteroid therapy for asthma exacerbation are still debated, and more research is needed to determine the best approach 4.
Efficacy and Safety
- Corticosteroids have been shown to reduce hospital admission rates and relapse risk in patients with asthma exacerbation 3.
- However, corticosteroids can also cause adverse events, such as increased blood sugar levels and weight gain 6, 7.
- A study found that the addition of a short-acting muscarinic antagonist and magnesium sulfate infusion to corticosteroid therapy was associated with fewer hospitalizations 5.