From the Guidelines
For an acute asthma exacerbation in the Emergency Department, methylprednisolone should be administered at a dose of 2 g over 20 minutes in adults and 25 to 75 mg/kg in children (up to a maximum of 2 g). This dose is based on the most recent and highest quality study available, which recommends this dosage for the treatment of acute asthma exacerbations in the ED 1. The key points to consider when administering methylprednisolone for acute asthma exacerbation include:
- The dose and frequency of administration, along with the frequency of patient monitoring, dependent on the severity of the exacerbation
- The total course of systemic corticosteroids for an asthma exacerbation requiring an ED visit or hospitalization may last from 3 to 10 days
- For corticosteroid courses of less than 1 week, there is no need to taper the dose
- Patients should be monitored for potential side effects including hyperglycemia, agitation, and electrolyte abnormalities, though these are less common with short-term use. It is also important to note that there is no known advantage for higher doses of corticosteroids in severe asthma exacerbations, nor is there any advantage for intravenous administration over oral therapy provided gastrointestinal transit time or absorption is not impaired 1. Additionally, other treatments such as heliox-driven albuterol nebulization and consultation with or comanagement by a physician expert in ventilator management may be considered in the treatment of acute asthma exacerbations 1.
From the FDA Drug Label
In other indications, initial dosage will vary from 10 mg to 40 mg of methylprednisolone depending on the specific disease entity being treated. The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone, or methylprednisolone in pediatric patients whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1 mg/kg/day to 2 mg/kg/day in single or divided doses
The correct dose of methylprednisolone for an acute asthma exacerbation in the Emergency Department (ED) is not explicitly stated for adults. However, for pediatric patients, the recommended dose is 1 mg/kg/day to 2 mg/kg/day in single or divided doses 2.
- For adults, the dosage may vary depending on the specific disease entity being treated, but the label does not provide a specific dose for acute asthma exacerbation.
- It is essential to note that 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
Methylprednisolone Dosing for Acute Asthma Exacerbation
- The correct dose of methylprednisolone for an acute asthma exacerbation in the Emergency Department (ED) is not explicitly stated in the provided studies, but we can look at the doses used in various studies for guidance.
- A study published in 1995 compared 100 mg with 500 mg of methylprednisolone in the emergency department treatment of acute asthma and found no difference in the FEV1 between the two dose groups 3.
- Another study from 1988 compared oral with intravenous methylprednisolone in status asthmaticus and used doses of 160 or 320 mg orally or 500 or 1000 mg intravenously, daily in equally divided doses 4.
- A study from 1993 used intravenous methylprednisolone, 60 mg every 6 hours, in adults hospitalized for acute asthma 5.
- A study from 1994 used 2 mg/kg of methylprednisolone IV in children with acute asthma 6.
Comparison of Doses
- The doses used in these studies vary, but the most common dose used in adults is 100-125 mg of methylprednisolone 3, 5.
- The study from 1994 used a dose of 2 mg/kg in children, which would be equivalent to a much lower dose in adults 6.
- The study from 1988 used higher doses of methylprednisolone, but found no significant difference between the oral and intravenous routes of administration 4.