What are the indications and dosing for prednisone (corticosteroid) in patients with difficulty breathing due to inflammatory conditions such as Chronic Obstructive Pulmonary Disease (COPD) or asthma?

From the Guidelines

Prednisone is indicated for acute exacerbations of COPD and asthma to reduce airway inflammation and improve breathing, with a recommended dose of 40mg daily for 5 days for COPD exacerbations, as supported by the most recent and highest quality study 1. The use of prednisone in patients with difficulty breathing due to inflammatory conditions such as COPD or asthma is a well-established practice.

• The benefits of prednisone in COPD exacerbations include shortening recovery time, improving lung function, and reducing the risk of early relapse, treatment failure, and length of hospitalization, as noted in the 2017 GOLD executive summary 1.
• For acute asthma exacerbations, prednisone is also effective in reducing airway inflammation and improving breathing, with typical dosing ranging from 40-60mg daily for 5-10 days, as mentioned in various studies 1.
• In severe asthma attacks requiring hospitalization, higher doses of prednisone may be used initially, and for chronic asthma management, the lowest effective dose should be used, often 5-10mg daily, with attempts to taper to alternate-day dosing when possible.
• Patients should take prednisone with food to minimize gastrointestinal side effects and be monitored for adverse effects, including hyperglycemia, mood changes, insomnia, and increased infection risk.
• The mechanism of action of prednisone involves suppressing inflammatory pathways and reducing the production of inflammatory mediators, thereby decreasing airway inflammation, mucus production, and bronchial hyperresponsiveness, which helps improve airflow and reduce symptoms like wheezing, coughing, and shortness of breath.
• It is essential to note that the dosing and duration of prednisone treatment may vary depending on the severity of the exacerbation and the individual patient's response to treatment, as highlighted in studies such as the 2017 European Respiratory Society/American Thoracic Society guideline 1.

From the FDA Drug Label

5 Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: Seasonal or perennial allergic rhinitis Bronchial asthma 8 Hematologic Disorders... No specific mention of COPD

The indications for prednisone in patients with difficulty breathing due to inflammatory conditions include Bronchial asthma.

• The dosing is variable and must be individualized based on the disease and patient response.
• The initial dosage of prednisone may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated 2.
• For Bronchial asthma, the dosage is not explicitly stated, but it is recommended to start with a low dose and adjust as needed to achieve a satisfactory response 2.

From the Research

Indications for Prednisone in Difficulty Breathing

• Prednisone, a corticosteroid, is used to treat inflammatory conditions such as Chronic Obstructive Pulmonary Disease (COPD) and asthma that cause difficulty breathing 3, 4, 5, 6.
• In asthma, oral steroids like prednisone are recommended for all but the most mild exacerbations and should be initiated promptly 3.
• For COPD, systemic corticosteroids like prednisone are used during acute exacerbations, and some evidence suggests that patients with COPD who respond to corticosteroids have eosinophilic inflammation and other attributes of an asthma phenotype 4, 5.

Dosing of Prednisone

• The optimal dosing of oral steroids for asthma exacerbations is not well established, and evidence is limited regarding the best dose or duration to maximize recovery while minimizing potential side effects 3.
• A study found that treatment with prednisone resulted in a more rapid improvement in arterial PO2, alveolar-arterial oxygen gradient, FEV1, and peak expiratory flow in patients with acute COPD exacerbation 5.
• Another study found that high-dose oral steroid treatment improved lung function over a short period, but the long-term use of oral steroids is not recommended due to potentially harmful adverse effects 6.

Alternative Treatments

• Nebulized corticosteroids can be an effective alternative to inhalers for delivering corticosteroids in asthma and COPD, especially for patients who are unwilling or unable to use inhalers 7.
• Nebulized budesonide has been demonstrated to be effective and safe in children and adults with asthma, and other nebulized corticosteroids like beclomethasone, fluticasone, and flunisolide have also shown promise 7.