From the Guidelines
For a 2-year-old child with an asthma exacerbation, the recommended oral steroid is prednisolone, with a typical dosage of 1-2 mg/kg body weight orally (maximum 40 mg) 1. The medication should be given once daily in the morning to minimize adrenal suppression. When administering oral steroids to young children with asthma exacerbations, it's essential to monitor for potential side effects such as increased appetite, mood changes, and gastrointestinal upset. These effects are usually temporary and resolve after completing the short course of treatment. The use of oral steroids in this context helps to quickly reduce airway inflammation and improve symptoms, allowing for faster recovery from the asthma exacerbation. Some studies suggest that the total course of systemic corticosteroids for an asthma exacerbation may last from 3 to 10 days, and for courses of less than 1 week, there is no need to taper the dose 1. However, the most recent and highest quality study is not available, but based on the available evidence, prednisolone is the preferred oral steroid for a 2-year-old child with an asthma exacerbation. It is also important to note that oxygen therapy and inhaled bronchodilators, such as salbutamol or terbutaline, should also be administered as part of the treatment plan for an asthma exacerbation 1.
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 recommended oral corticosteroid for a 2-year-old child with an asthma exacerbation is prednisolone or prednisone or methylprednisolone.
- The recommended dose is 1-2 mg/kg/day in single or divided doses 2.
From the Research
Oral Corticosteroids for Asthma Exacerbation in Children
- The management of asthma exacerbations in children often involves the use of oral corticosteroids to reduce inflammation and prevent further exacerbation 3.
- According to a study published in 2002, oral prednisolone is recommended as the treatment of choice for severe asthma exacerbations in children due to its reliability, simplicity, convenience, and low cost 3.
- However, more recent studies have compared the efficacy of oral prednisolone with oral dexamethasone in the management of acute asthma exacerbations in children.
- A 2022 study found that oral dexamethasone (0.3 mg/kg) was more effective than oral prednisolone (1 mg/kg) in reducing symptoms and improving outcomes in children with mild to moderate asthma exacerbations 4.
- Another study published in 2006 found that a single dose of oral dexamethasone (0.6 mg/kg) was no worse than a 5-day course of oral prednisolone (1 mg/kg) in the management of children with mild to moderate asthma exacerbations 5.
- A 2016 review of oral corticosteroid regimens for acute asthma found no convincing evidence of differences in outcomes between higher and lower doses of prednisolone or dexamethasone, or between prednisolone and dexamethasone 6.
- A 2020 review of oral corticosteroids and asthma in children highlighted the importance of considering the efficacy and safety of different oral corticosteroid regimens in the management of asthma exacerbations in children 7.
Recommended Oral Corticosteroid for a 2-year-old Child
- Based on the available evidence, oral dexamethasone (0.3-0.6 mg/kg) may be a suitable option for the management of asthma exacerbations in children, including 2-year-old children 4, 5.
- However, the choice of oral corticosteroid and dosage should be individualized and based on the severity of the exacerbation, the child's medical history, and other factors 3, 6, 7.